Edouard Girard1,2,3, Julio Abba4, Bastien Boussat5,6, Bertrand Trilling4,5, Adrian Mancini4, Pierre Bouzat7, Christian Létoublon4, Mircea Chirica4, Catherine Arvieux4. 1. Digestive and Emergency Surgery Department, Grenoble-Alpes University Hospital, Grenoble, France. egirard1@chu-grenoble.fr. 2. TIMC Research Unit, CNRS, Grenoble-Alpes University, Grenoble, France. egirard1@chu-grenoble.fr. 3. Service de Chirurgie Digestive et Générale, Hôpital Michallon, Centre Hospitalier Universitaire Grenoble-Alpes, Boulevard de la Chantourne, 38700, Grenoble, La Tronche, France. egirard1@chu-grenoble.fr. 4. Digestive and Emergency Surgery Department, Grenoble-Alpes University Hospital, Grenoble, France. 5. TIMC Research Unit, CNRS, Grenoble-Alpes University, Grenoble, France. 6. Quality of Care Unit, Grenoble-Alpes University Hospital, Grenoble, France. 7. Anesthesiology and Intensive Care Medicine, Grenoble-Alpes University Hospital, Grenoble, France.
Abstract
BACKGROUND: Damage control surgery (DCS) was a major paradigm change in the management of critically ill trauma patients and has gradually expanded in the general surgery arena, but data in this setting are still scarce. The study aim was to evaluate outcomes of DCS in patients with general surgery emergencies. METHODS: Between 2005 and 2015, 164 patients (104 men, age 66) underwent DCS for non-traumatic abdominal emergencies. The decision to perform DCS was triggered by the presence of at least one trauma DCS criterion: hypotension (<70 mmHg), hypothermia (<35 °C), acidosis (pH < 7.25), coagulopathy (INR ≥ 1.7) and massive (>5 RBC) transfusion. Statistical tests were performed to identify risk factors for operative mortality. Observed outcomes were compared to those predicted by commonly employed scores (APACHE II, POSSUM, P-POSSUM, SAPS II). RESULTS: DCS was performed for acute mesenteric ischemia (n = 68), peritonitis (n = 44), pancreatitis (n = 28), bleeding (n = 14) and other (n = 10). Abdominal compartment syndrome was associated in 52 patients (32%). Seventy-four (45%) patients died and 150 patients (91%) experienced complications. On multivariate analysis, age (p = 0.018) and INR ≥ 1.7 (p = 0.001) were independent predictors of mortality. Mortality was 24% (13/55), 48% (22/46) and 62% (39/63) in patients with one, two and ≥3 DCS criteria, respectively. Comparison of observed and score-predicted mortality suggested DCS use resulted in significant survival benefit of the whole cohort and of patients with pancreatitis and postoperative peritonitis. CONCLUSIONS: DCS can be lifesaving in critically ill patients with general surgery emergencies. Patients with peritonitis and acute pancreatitis are those who benefit most of the DCS approach.
BACKGROUND: Damage control surgery (DCS) was a major paradigm change in the management of critically ill traumapatients and has gradually expanded in the general surgery arena, but data in this setting are still scarce. The study aim was to evaluate outcomes of DCS in patients with general surgery emergencies. METHODS: Between 2005 and 2015, 164 patients (104 men, age 66) underwent DCS for non-traumatic abdominal emergencies. The decision to perform DCS was triggered by the presence of at least one traumaDCS criterion: hypotension (<70 mmHg), hypothermia (<35 °C), acidosis (pH < 7.25), coagulopathy (INR ≥ 1.7) and massive (>5 RBC) transfusion. Statistical tests were performed to identify risk factors for operative mortality. Observed outcomes were compared to those predicted by commonly employed scores (APACHE II, POSSUM, P-POSSUM, SAPS II). RESULTS:DCS was performed for acute mesenteric ischemia (n = 68), peritonitis (n = 44), pancreatitis (n = 28), bleeding (n = 14) and other (n = 10). Abdominal compartment syndrome was associated in 52 patients (32%). Seventy-four (45%) patients died and 150 patients (91%) experienced complications. On multivariate analysis, age (p = 0.018) and INR ≥ 1.7 (p = 0.001) were independent predictors of mortality. Mortality was 24% (13/55), 48% (22/46) and 62% (39/63) in patients with one, two and ≥3 DCS criteria, respectively. Comparison of observed and score-predicted mortality suggested DCS use resulted in significant survival benefit of the whole cohort and of patients with pancreatitis and postoperative peritonitis. CONCLUSIONS:DCS can be lifesaving in critically illpatients with general surgery emergencies. Patients with peritonitis and acute pancreatitis are those who benefit most of the DCS approach.
Authors: Anuradha Subramanian; Courtney Balentine; Carlos H Palacio; Shubhada Sansgiry; David H Berger; Samir S Awad Journal: Am J Surg Date: 2010-12 Impact factor: 2.565
Authors: Matthew D Tadlock; Michael J Sise; Steven T Riccoboni; C Beth Sise; Daniel I Sack; Robert G Sise; Jack C Yang; Jeffrey J Borut; Bryan S King Journal: Vasc Endovascular Surg Date: 2010-07-30 Impact factor: 1.089
Authors: Alexander Perathoner; Alexander Klaus; Gilbert Mühlmann; Michael Oberwalder; Raimund Margreiter; Reinhold Kafka-Ritsch Journal: Int J Colorectal Dis Date: 2010-02-11 Impact factor: 2.571
Authors: Reinhold Kafka-Ritsch; Franz Birkfellner; Alexander Perathoner; Helmut Raab; Hermann Nehoda; Johann Pratschke; Matthias Zitt Journal: J Gastrointest Surg Date: 2012-07-28 Impact factor: 3.452
Authors: Brandon R Bruns; Sarwat A Ahmad; Lindsay OʼMeara; Ronald Tesoriero; Margaret Lauerman; Elena Klyushnenkova; Rosemary Kozar; Thomas M Scalea; Jose J Diaz Journal: J Trauma Acute Care Surg Date: 2016-04 Impact factor: 3.313
Authors: Carlos A Ordoñez; Michael Parra; Alberto García; Fernando Rodríguez; Yaset Caicedo; José Julián Serna; Alexander Salcedo; Josefa Franco; Luis Eduardo Toro; Juliana Ordoñez; Luis Fernando Pino; Mónica Guzmán; Claudia Orlas; Juan Pablo Herrera; Gonzalo Aristizábal; Francesco Pata; Salomone Di Saverio Journal: World J Surg Date: 2020-11-05 Impact factor: 3.352
Authors: Andrew S Miller; Kathryn Boyce; Benjamin Box; Matthew D Clarke; Sarah E Duff; Niamh M Foley; Richard J Guy; Lisa H Massey; George Ramsay; Dominic A J Slade; James A Stephenson; Phil J Tozer; Danette Wright Journal: Colorectal Dis Date: 2021-02 Impact factor: 3.917
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: Carlos A Ordoñez; Yaset Caicedo; Michael W Parra; Fernando Rodríguez-Holguín; José Julián Serna; Alexander Salcedo; María Josefa Franco; Luis Eduardo Toro; Luis Fernando Pino; Mónica Guzmán-Rodríguez; Claudia Orlas; Juan Pablo Herrera-Escobar; Adolfo González-Hadad; Mario Alain Herrera; Gonzalo Aristizábal; Alberto García Journal: Colomb Med (Cali) Date: 2021-06-30