"Damage control" in the elderly: futile endeavor or fruitful enterprise?

BACKGROUND

Damage control laparotomy (DCL) provides effective management in carefully selected, exsanguinating trauma patients. However, the effectiveness of this approach has not been examined in the elderly. The purpose of this study was to characterize elderly DCL patients.

METHODS

The National Trauma Registry of the American College of Surgeons was queried for patients admitted to our Level I trauma center between January 2003 and June 2008. Patients who underwent a DCL were included in the study. Elderly (55 years or older) and young (16-54 years) patients were compared for demographics, injury severity, intraoperative transfusion volume, complications, and mortality.

RESULTS

During the study period, 62 patients met inclusion criteria. Elderly and young cohorts were similar in gender (male, 78.6% vs. 75.0%, p = 0.78), Injury Severity Score (25.1 ± 2.1 vs. 23.8 ± 1.7, p = 0.49), packed red blood cell transfusion volume (3036 mL ± 2760 mL vs. 2654 mL ± 2194 mL, p = 0.51), and number of complications (3.21 ± 0.48 vs. 3.33 ± 0.38, p = 0.96). Mortality was greater in the elderly cohort (42.9% vs. 12.5%, p = 0.02). The mean time to death for the elderly was 9.8 days ± 10.2 days and 26 days ± 21.5 days in the young (p = 0.485).

CONCLUSIONS

Despite the severity of injury, the outcome of elderly DCL patients is better than what might be predicted. They succumb to their injuries more frequently and earlier in the hospital course compared with the young, but the majority of these patients survive. DCL in the elderly is not a futile endeavor.