RT Journal Article
SR Electronic
T1 Six-year national study of damage control laparotomy and the effect of repeat re-exploration on rate of infectious complications
JF Trauma Surgery & Acute Care Open
JO Trauma Surg Acute Care Open
FD BMJ Publishing Group Ltd
SP e000706
DO 10.1136/tsaco-2021-000706
VO 6
IS 1
A1 Foster, Krislyn
A1 Yon, James
A1 Pelzl, Casey E
A1 Salottolo, Kristin
A1 Mentzer, Caleb
A1 Quan, Glenda
A1 McGuire, Emmett E
A1 Katubig, Burt
A1 Bar-Or, David
YR 2021
UL http://tsaco.bmj.com/content/6/1/e000706.abstract
AB Background Damage control laparotomy (DCL) is a life-saving procedure in patients with abdominal hemorrhage. After DCL, patients are sometimes left with an open abdomen (OA) so they may undergo multiple exploratory laparotomies (EXLAP), or re-explorations. Patients with OA are at increased risk of infectious complications (ICs). The association between number of re-explorations after DCL and the number of ICs is not clear. We hypothesized that each additional re-exploration increases the risk of developing IC.Methods This 6-year retrospective cohort study included patients aged ≥16 years from the NTDB who had DCL defined as EXLAP within 2 hours of arrival (ICD-9: 54.11, 54.12, 54.19) with at least one re-exploration. The primary outcome was IC (ie, superficial surgical site infection (SSI), organ space SSI, deep SSI, sepsis, pneumonia, or catheter-related bloodstream infection), examined dichotomously (present/absent) and ordinally as the number of ICs. Multivariate Poisson regression was used to assess the association between number of re-explorations and number of ICs. Significance was assigned at p<0.01.Results There were 7431 patients who underwent DCL; 2509 (34%) patients developed at least one IC. The rate of IC was lowest in patients who were closed during the first re-exploration (27%) and significantly increased with each re-exploration to 59% in patients who had five or more re-explorations (Cochran-Armitage trend p<0.001). After adjustment, there was 14% increased risk of an additional IC with each re-exploration (p<0.001).Discussion For patients requiring DCL, each re-exploration of the abdomen is associated with increased rate of ICs.Level of evidence III, retrospective epidemiological study.Data are available in a public, open-access repository. Data used in this study are publicly available via the National Trauma Data Bank: https://www.facs.org/quality-programs/trauma/tqp/center-programs/ntdb/datasets.