Long term impact of damage control surgery: a preliminary prospective study.

BACKGROUND

To evaluate the impact of damage control laparotomy on long term morbidity and survival.

METHODS

Prospective data were collected on 56 consecutive trauma patients over a 20-month period (May 2000-January 2002). Patients were stratified by mechanism of injury, age, Injury Severity Score, and type of injury, temperature at admission, initial blood transfusion volume and pH. Initial outcome data included major complications, intensive care unit and hospital length of stay, and mortality. Readmission data including number of admissions, surgical procedures, and hospital length of stay were then analyzed over the subsequent follow-up years (2001-2003).

RESULTS

The mean age of the study group was 31 +/- 11 years with a mean Injury Severity Score of 33 +/- 13. The majority of the patients were male (73%) with a relatively equal number of blunt (n = 30) and penetrating injuries (n = 26). Liver injuries (34 [61%]) were the most common solid organ injury followed by 22 bowel (39%), 19 spleen (34%), 11 major vessel (20%), and 7 pancreas (13%) injuries. The mean number of initial abdominal surgical procedures was 4.4 +/- 2.2 per patient. The overall mortality during the first admission was 27%. Time spent in the intensive care unit and hospital length of stay was 17 +/- 13 and 30 +/- 19 days, respectively. There were a total of 74 readmissions and 58 subsequent surgical procedures in the 41 patients who were readmitted. Thirty-one (76%) patients were re-admitted at least one time. Infection (n = 19) was the most common reason for readmission followed by ventral hernia repair (n = 17) and fistula management (n = 14). There was 0% mortality for patients who survived the preliminary hospitalization but required readmission.

CONCLUSION

Although damage control laparotomy is associated with a significant complication and readmission rate, its long term survival and benefit is indisputable.