Derek J Roberts1, David A Zygun2, Peter D Faris3, Chad G Ball4, Andrew W Kirkpatrick5, Henry T Stelfox6. 1. Department of Surgery, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada. Electronic address: Derek.Roberts01@gmail.com. 2. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada. 3. Alberta Health Sciences Research-Research Analytics, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada. 4. Department of Surgery, University of Calgary, Calgary, Alberta, Canada; Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada. 5. Department of Surgery, University of Calgary, Calgary, Alberta, Canada; Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada. 6. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Abstract
BACKGROUND: Variation in use of damage control (DC) surgery across trauma centers may be partially driven by surgeon uncertainty as to when it is appropriately indicated. We sought to determine opinions of practicing surgeons on the appropriateness of published indications for trauma DC surgery. STUDY DESIGN: We asked 384 trauma centers in the United States, Canada, and Australasia to nominate 1 to 3 surgeons at their center to participate in a survey about DC surgery. We then asked nominated surgeons their opinions on the appropriateness (benefit-to-harm ratio) of 43 literature-derived indications for use of DC surgery in adult civilian trauma patients. RESULTS: In total, 232 (64.8%) trauma centers nominated 366 surgeons, of whom 201 (56.0%) responded. Respondents rated 15 (78.9%) preoperative and 23 (95.8%) intraoperative indications to be appropriate. Indications respondents agreed had the greatest expected benefit included a temperature <34°C, arterial pH <7.2, and laboratory-confirmed (international normalized ratio/prothrombin time and/or partial thromboplastin time >1.5 times normal) or clinically observed coagulopathy in the pre- or intraoperative setting; administration of >10 units of packed red blood cells; requirement for a resuscitative thoracotomy in the emergency department; and identification of a juxtahepatic venous injury or devascularized or destroyed pancreas, duodenum, or pancreaticoduodenal complex during operation. Ratings were consistent across subgroups of surgeons with different training, experience, and practice settings. CONCLUSIONS: We identified 38 indications that practicing surgeons agreed appropriately justified the use of DC surgery. Until further studies become available, these indications constitute a consensus opinion that can be used to guide practice in the current era of changing trauma resuscitation practices.
BACKGROUND: Variation in use of damage control (DC) surgery across trauma centers may be partially driven by surgeon uncertainty as to when it is appropriately indicated. We sought to determine opinions of practicing surgeons on the appropriateness of published indications for trauma DC surgery. STUDY DESIGN: We asked 384 trauma centers in the United States, Canada, and Australasia to nominate 1 to 3 surgeons at their center to participate in a survey about DC surgery. We then asked nominated surgeons their opinions on the appropriateness (benefit-to-harm ratio) of 43 literature-derived indications for use of DC surgery in adult civilian traumapatients. RESULTS: In total, 232 (64.8%) trauma centers nominated 366 surgeons, of whom 201 (56.0%) responded. Respondents rated 15 (78.9%) preoperative and 23 (95.8%) intraoperative indications to be appropriate. Indications respondents agreed had the greatest expected benefit included a temperature <34°C, arterial pH <7.2, and laboratory-confirmed (international normalized ratio/prothrombin time and/or partial thromboplastin time >1.5 times normal) or clinically observed coagulopathy in the pre- or intraoperative setting; administration of >10 units of packed red blood cells; requirement for a resuscitative thoracotomy in the emergency department; and identification of a juxtahepatic venous injury or devascularized or destroyed pancreas, duodenum, or pancreaticoduodenal complex during operation. Ratings were consistent across subgroups of surgeons with different training, experience, and practice settings. CONCLUSIONS: We identified 38 indications that practicing surgeons agreed appropriately justified the use of DC surgery. Until further studies become available, these indications constitute a consensus opinion that can be used to guide practice in the current era of changing trauma resuscitation practices.
Authors: Tyler J Loftus; Philip A Efron; Trina M Bala; Martin D Rosenthal; Chasen A Croft; Michael S Walters; R Stephen Smith; Frederick A Moore; Alicia M Mohr; Scott C Brakenridge Journal: J Trauma Acute Care Surg Date: 2019-04 Impact factor: 3.313
Authors: John A Harvin; Lillian S Kao; Mike K Liang; Sasha D Adams; Michelle K McNutt; Joseph D Love; Laura J Moore; Charles E Wade; Bryan A Cotton; John B Holcomb Journal: J Am Coll Surg Date: 2017-04-23 Impact factor: 6.113
Authors: Federico Coccolini; Derek Roberts; Luca Ansaloni; Rao Ivatury; Emiliano Gamberini; Yoram Kluger; Ernest E Moore; Raul Coimbra; Andrew W Kirkpatrick; Bruno M Pereira; Giulia Montori; Marco Ceresoli; Fikri M Abu-Zidan; Massimo Sartelli; George Velmahos; Gustavo Pereira Fraga; Ari Leppaniemi; Matti Tolonen; Joseph Galante; Tarek Razek; Ron Maier; Miklosh Bala; Boris Sakakushev; Vladimir Khokha; Manu Malbrain; Vanni Agnoletti; Andrew Peitzman; Zaza Demetrashvili; Michael Sugrue; Salomone Di Saverio; Ingo Martzi; Kjetil Soreide; Walter Biffl; Paula Ferrada; Neil Parry; Philippe Montravers; Rita Maria Melotti; Francesco Salvetti; Tino M Valetti; Thomas Scalea; Osvaldo Chiara; Stefania Cimbanassi; Jeffry L Kashuk; Martha Larrea; Juan Alberto Martinez Hernandez; Heng-Fu Lin; Mircea Chirica; Catherine Arvieux; Camilla Bing; Tal Horer; Belinda De Simone; Peter Masiakos; Viktor Reva; Nicola DeAngelis; Kaoru Kike; Zsolt J Balogh; Paola Fugazzola; Matteo Tomasoni; Rifat Latifi; Noel Naidoo; Dieter Weber; Lauri Handolin; Kenji Inaba; Andreas Hecker; Yuan Kuo-Ching; Carlos A Ordoñez; Sandro Rizoli; Carlos Augusto Gomes; Marc De Moya; Imtiaz Wani; Alain Chichom Mefire; Ken Boffard; Lena Napolitano; Fausto Catena Journal: World J Emerg Surg Date: 2018-02-02 Impact factor: 5.469
Authors: Ross Weale; Victor Kong; Johan Buitendag; Abraham Ras; Joanna Blodgett; Grant Laing; John Bruce; Wanda Bekker; Vassil Manchev; Damian Clarke Journal: Trauma Surg Acute Care Open Date: 2019-04-16
Authors: Derek J Roberts; David A Zygun; Chad G Ball; Andrew W Kirkpatrick; Peter D Faris; Matthew T James; Kelly J Mrklas; Brenda D Hemmelgarn; Braden Manns; Henry T Stelfox Journal: BMC Surg Date: 2019-08-27 Impact factor: 2.102
Authors: Derek J Roberts; Niklas Bobrovitz; David A Zygun; Andrew W Kirkpatrick; Chad G Ball; Peter D Faris; Henry T Stelfox Journal: World J Emerg Surg Date: 2021-03-11 Impact factor: 5.469
Authors: Derek J Roberts; Peter D Faris; Chad G Ball; Andrew W Kirkpatrick; Ernest E Moore; David V Feliciano; Peter Rhee; Scott D'Amours; Henry T Stelfox Journal: World J Emerg Surg Date: 2021-10-14 Impact factor: 5.469
Authors: John A Harvin; Jeanette Podbielski; Laura E Vincent; Erin E Fox; Laura J Moore; Bryan A Cotton; Charles E Wade; John B Holcomb Journal: Trauma Surg Acute Care Open Date: 2017-04-13