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Open Access

Six-year national study of damage control laparotomy and the effect of repeat re-exploration on rate of infectious complications

Krislyn Foster, James Yon, Casey E Pelzl, Kristin Salottolo, Caleb Mentzer, Glenda Quan, Emmett E McGuire, Burt Katubig, David Bar-Or
DOI: 10.1136/tsaco-2021-000706 Published 15 June 2021
Krislyn Foster
1Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
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James Yon
1Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
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Casey E Pelzl
2Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA
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Kristin Salottolo
2Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA
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Caleb Mentzer
3Department of Surgery, Spartanburg Regional, Spartanburg, South Carolina, USA
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Glenda Quan
1Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
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Emmett E McGuire
1Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
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Burt Katubig
1Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
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David Bar-Or
1Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
2Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA
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Article Figures & Data

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    Figure 1

    Histogram demonstrating rate (%) of an infectious complication by number of re-explorations.

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    Figure 2

    Histogram demonstrating number of infectious complications by number of re-explorations. IC, infectious complication.

Tables

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  • Table 1

    Associations of variables with developing an infectious complication

    Variable, n (%)No IC
    4922 (66.2)
    IC
    2509 (33.8)
    P value
    Number of re-explorations<0.001
     13503 (71.2)1270 (50.6)
     2834 (16.9)561 (22.4)
     3278 (5.7)265 (10.6)
     4134 (2.7)159 (6.3)
     ≥5173 (3.5)254 (10.1)
    Age, ≥55 years716 (14.6)436 (17.4)0.001
    Male3951 (80.3)2048 (81.6)0.172
    Blunt mechanism2023 (41.2)1151 (45.9)<0.001
    Interhospital transfer733 (14.9)349 (13.9)0.256
     Comorbidities
     Hypertension523 (10.6)344 (13.7)<0.001
     Alcoholism304 (6.2)181 (7.2)0.087
     Respiratory disease175 (3.6)119 (4.7)0.013
     Bleeding disorder90 (1.8)74 (3.0)0.002
     Diabetes mellitus216 (4.4)132 (5.3)0.092
     Current smoker812 (16.5)481 (19.2)0.004
     Obesity253 (5.1)198 (7.9)<0.001
     Cirrhosis84 (1.7)27 (1.1)0.034
     Drug abuse or dependence274 (5.6)159 (6.3)0.180
    Injury Severity Score<0.001
     <161111 (22.6)335 (13.3)
     ≥163811 (77.4)2174 (86.7)
    Glasgow Coma Scale score0.001
     13–153215 (65.3)1544 (61.5)
     3–121707 (34.7)965 (38.5)
    Abnormal ED vital signs
     Oxygen saturation <95%714 (17.0)444 (20.7)<0.001
     Temperature <36.4°C or >37.6°C3560 (72.3)1889 (75.3)0.006
     Pulse <60 or >100 beats/min2864 (59.4)1587 (64.4)<0.001
     SBP <90 mm Hg1362 (27.7)720 (28.7)0.352
     RR <12 or >16 breaths/min3749 (80.6)1947 (82.9)0.020
    In-hospital mortality833 (16.9)283 (11.3)<0.001
    HLOS (days)<0.001
     1–61011 (20.5)40 (1.6)
     >73911 (79.5)2469 (98.4)
    ICULOS (days)<0.001
     0291 (5.9)56 (2.2)
     1–62490 (50.6)391 (15.6)
     >72141 (43.5)2062 (82.2)
    Ventilator days<0.001
     0771 (15.7)172 (6.9)
     1–52446 (49.7)474 (18.9)
     >51705 (34.6)1863 (74.2)
    • Bolded p values indicate statistical significance.

    • ED, emergency department; HLOS, hospital length of stay; IC, infectious complication; ICULOS, intensive care unit length of stay; RR, respiratory rate; SBP, systolic blood pressure.

  • Table 2

    Associations of variables with multiple re-explorations

    Variable, n (%)1 re-exploration
    4773 (64.2)
    >1 re-exploration
    2658 (35.8)
    P value
    Any infectious complications1270 (26.6)1239 (46.6)<0.001
    Age, ≥55 years725 (15.2)427 (16.1)0.318
    Male3875 (81.2)2124 (79.9)0.170
    Blunt mechanism2017 (42.3)1157 (43.6)0.786
    Interhospital transfer709 (14.8)373 (14.0)0.336
    Comorbidities
     Hypertension542 (11.4)325 (12.2)0.262
     Alcoholism296 (6.2)189 (7.1)0.128
     Respiratory disease181 (3.8)113 (4.2)0.330
     Bleeding disorder100 (2.1)64 (2.4)0.379
     Diabetes mellitus214 (4.5)134 (5.0)0.275
     Current smoker863 (18.1)430 (16.2)0.038
     Obesity273 (5.7)178 (6.7)0.091
     Cirrhosis63 (1.3)48 (1.8)0.098
     Drug abuse or dependence279 (5.9)154 (5.8)0.928
    Injury Severity Score<0.001
     <161019 (21.4)427 (16.1)
     ≥163754 (78.6)2231 (83.9)
    Glasgow Coma Scale score0.241
     13–153080 (64.5)1679 (63.2)
     3–121693 (35.5)979 (36.8)
    Abnormal ED vital signs
     Oxygen saturation <95%707 (17.2)451 (20.1)0.005
     Temperature <36.4°C or >37.6°C3440 (72.1)2009 (75.6)0.001
     Pulse <60 or >100 beats/min2765 (59.0)1686 (64.8)<0.001
     SBP <90 mm Hg1266 (26.5)816 (30.7)<0.001
     RR <12 or >16 breaths/min3641 (80.7)2055 (82.7)0.038
    In-hospital mortality382 (14.3)434 (16.3)0.018
    HLOS (days)<0.001
     1–7888 (18.6)163 (6.1)
     >73885 (81.4)2495 (93.9)
    ICULOS (days)<0.001
     0294 (6.2)53 (2.0)
     1–72358 (49.4)523 (19.7)
     >72121 (44.4)2082 (78.3)
    Ventilator days<0.001
     0770 (16.1)173 (6.5)
     1–52297 (48.1)623 (23.4)
     >51706 (35.7)1862 (70.1)
    • Bolded p values indicate statistical significance.

    • ED, emergency department; HLOS, hospital length of stay; ; ICULOS, intensive care unit length of stay; RR, respiratory rate; SBP, systolic blood pressure.

  • Table 3

    Poisson regression model building—effect of covariates on number of infectious complications

    Risk RatioModel 1Model 2Model 3Model 4Model 5Model 6Model 7Model 8
    Number of re-explorations1.141.141.141.141.141.141.141.14
    Age ≥551.211.181.151.141.12
    Blunt injury1.06
    Hypertension1.181.151.181.231.17
    Bleeding disorder
    Obesity1.241.241.251.22
    Current smoker
    Injury Severity Score ≥161.551.551.49
    Glasgow Coma Scale score <13
    Oxygen saturation <95%1.10
    Temperature <36.4°C or >37.6°C
    Pulse <60 or >100 beats/min
    SBP <90 mm Hg
    AIC13 18113 16613 16513 15913 15013 07213 07511 223
    Risk ratioModel 9Model 10Model 11Model 12Model 13Model 14Model 15Model 16 (final)P value
    Number of re-explorations1.141.141.141.141.141.141.141.14<0.001
    Age ≥551.12
    Blunt injury
    Hypertension1.241.231.231.241.231.191.151.19<0.001
    Bleeding disorder1.431.371.43<0.001
    Obesity1.241.251.241.251.241.241.241.240.001
    Current smoker1.231.231.241.23<0.001
    Injury Severity Score ≥161.531.561.541.531.561.561.551.56<0.001
    Glasgow Coma Scale score <131.06
    Oxygen saturation <95%
    Temperature <36.4°C or >37.6°C1.08
    Pulse <60 or >100 beats/min1.08
    SBP <90 mm Hg0.99
    AIC12 82913 07713 07313 07513 05613 04613 04213 046
    • AIC, Akaike information criterion; rr, remove from abbreviations list.; SBP, systolic blood pressure.

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Six-year national study of damage control laparotomy and the effect of repeat re-exploration on rate of infectious complications
Krislyn Foster, James Yon, Casey E Pelzl, Kristin Salottolo, Caleb Mentzer, Glenda Quan, Emmett E McGuire, Burt Katubig, David Bar-Or
Trauma Surg Acute Care Open Jun 2021, 6 (1) e000706; DOI: 10.1136/tsaco-2021-000706

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Six-year national study of damage control laparotomy and the effect of repeat re-exploration on rate of infectious complications
Krislyn Foster, James Yon, Casey E Pelzl, Kristin Salottolo, Caleb Mentzer, Glenda Quan, Emmett E McGuire, Burt Katubig, David Bar-Or
Trauma Surg Acute Care Open Jun 2021, 6 (1) e000706; DOI: 10.1136/tsaco-2021-000706
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Six-year national study of damage control laparotomy and the effect of repeat re-exploration on rate of infectious complications
Krislyn Foster, James Yon, Casey E Pelzl, Kristin Salottolo, Caleb Mentzer, Glenda Quan, Emmett E McGuire, Burt Katubig, David Bar-Or
Trauma Surgery & Acute Care Open Jun 2021, 6 (1) e000706; DOI: 10.1136/tsaco-2021-000706
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