BACKGROUND: Trauma surgery is in constant evolution as is the use of damage control laparotomy (DCL). The purpose of this study was to report the change in usage of DCL over time and its effect on outcome. METHODS: Trauma patients requiring laparotomies during a 3-year (2006-2008) period were reviewed. DCL was defined as laparotomy when fascia was not closed at the first operation. RESULTS: There were 14,534 trauma patients evaluated, and 843 laparotomies were performed on 532 patients during the study period. The number of patients requiring open laparotomies slightly increased while the demographics and Injury Severity Score were similar during the study period. The number of patient requiring DCL significantly decreased from 36.3% (53 of 146) in 2006 to 8.8% (15 of 170) in 2008 (p < 0.001). During this same time period, the mortality rate for patients requiring open laparotomy significantly decreased from 21.9% in 2006 to 12.9% in 2008 (p = 0.05). The decreased use of DCL resulted in a 33.3% reduction in the number of laparotomies performed. The decrease in average costs and charges is projected to result in savings of $2.2 million and $5.8 million, respectively. CONCLUSIONS: The use of DCL was significantly decreased by 78% during the study with significantly improved outcome. The improved outcome and decreased resource utilization can reduce health care costs and charges. Although DCL may be a vital aspect of trauma surgery, it can be used more selectively with improved outcome.
BACKGROUND:Trauma surgery is in constant evolution as is the use of damage control laparotomy (DCL). The purpose of this study was to report the change in usage of DCL over time and its effect on outcome. METHODS:Traumapatients requiring laparotomies during a 3-year (2006-2008) period were reviewed. DCL was defined as laparotomy when fascia was not closed at the first operation. RESULTS: There were 14,534 traumapatients evaluated, and 843 laparotomies were performed on 532 patients during the study period. The number of patients requiring open laparotomies slightly increased while the demographics and Injury Severity Score were similar during the study period. The number of patient requiring DCL significantly decreased from 36.3% (53 of 146) in 2006 to 8.8% (15 of 170) in 2008 (p < 0.001). During this same time period, the mortality rate for patients requiring open laparotomy significantly decreased from 21.9% in 2006 to 12.9% in 2008 (p = 0.05). The decreased use of DCL resulted in a 33.3% reduction in the number of laparotomies performed. The decrease in average costs and charges is projected to result in savings of $2.2 million and $5.8 million, respectively. CONCLUSIONS: The use of DCL was significantly decreased by 78% during the study with significantly improved outcome. The improved outcome and decreased resource utilization can reduce health care costs and charges. Although DCL may be a vital aspect of trauma surgery, it can be used more selectively with improved outcome.
Authors: John A Harvin; John P Sharpe; Martin A Croce; Michael D Goodman; Timothy A Pritts; Elizabeth D Dauer; Benjamin J Moran; Rachel D Rodriguez; Ben L Zarzaur; Laura A Kreiner; Jeffrey A Claridge; John B Holcomb Journal: J Trauma Acute Care Surg Date: 2019-08 Impact factor: 3.313
Authors: Talia A Sorrentino; Ernest E Moore; Max V Wohlauer; Walter L Biffl; Fredric M Pieracci; Jeffrey L Johnson; Carlton C Barnett; Denis D Bensard; Clay Cothren Burlew Journal: J Surg Res Date: 2012-05-24 Impact factor: 2.192
Authors: Justin Jeremiah Joseph Watson; Jamison Nielsen; Kyle Hart; Priya Srikanth; John D Yonge; Christopher R Connelly; Phillip M Kemp Bohan; Hillary Sosnovske; Barbara C Tilley; Gerald van Belle; Bryan A Cotton; Terence S OʼKeeffe; Eileen M Bulger; Karen J Brasel; John B Holcomb; Martin A Schreiber Journal: J Trauma Acute Care Surg Date: 2017-03 Impact factor: 3.313
Authors: Mitchell J George; Sasha D Adams; Michelle K McNutt; Joseph D Love; Rondel Albarado; Laura J Moore; Charles E Wade; Bryan A Cotton; John B Holcomb; John A Harvin Journal: Am J Surg Date: 2017-11-11 Impact factor: 2.565