Derek J Roberts1, Henry T Stelfox2, Laura J Moore3, Bryan A Cotton3, John B Holcomb3, John A Harvin3. 1. Division of Vascular and Endovascular Surgery, Department of Surgery, Ottawa, Ontario, Canada. Electronic address: Derek.Roberts01@gmail.com. 2. Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 3. Department of Surgery, The University of Texas Health Science Center, Houston, Texas; Center for Translational Injury Research, The University of Texas Health Science Center, Houston, Texas.
Abstract
BACKGROUND: Although studies have identified published indications that experts and practicing surgeons agree indicate use of damage control (DC) laparotomy, it is unknown whether these indications predict use of the procedure in practice. MATERIALS AND METHODS: We conducted a diagnostic performance study of the accuracy of a set of published appropriateness indications for predicting use of DC laparotomy. We included consecutive adults that underwent emergent laparotomy for trauma (2011-2016) at Memorial Hermann Hospital. RESULTS: We included 1141 injured adults. Two published preoperative appropriateness indications [a systolic blood pressure (BP) persistently <90 mmHg or core body temperature <34°C] produced moderate shifts in the pretest probability of conducting DC instead of definitive laparotomy. Five published intraoperative appropriateness indications produced large and often conclusive changes in the pretest probability of conducting DC during emergent laparotomy. These included the finding of a devascularized or completely disrupted pancreas, duodenum, or pancreaticoduodenal complex; an estimated intraoperative blood loss >4 L; administration of >10 U of packed red blood cells (PRBCs); and a systolic BP persistently <90 mmHg or arterial pH persistently <7.2 during operation. Most indications that produced large changes in the pretest probability of conducting DC laparotomy had an incidence of 2% or less. CONCLUSIONS: This study suggests that published appropriateness indications accurately predict use of DC laparotomy in practice. Intraoperative variables exert greater influence on the decision to conduct DC laparotomy than preoperative variables, and those indications that produce large shifts in the pretest probability of conducting DC laparotomy are uncommonly encountered.
BACKGROUND: Although studies have identified published indications that experts and practicing surgeons agree indicate use of damage control (DC) laparotomy, it is unknown whether these indications predict use of the procedure in practice. MATERIALS AND METHODS: We conducted a diagnostic performance study of the accuracy of a set of published appropriateness indications for predicting use of DC laparotomy. We included consecutive adults that underwent emergent laparotomy for trauma (2011-2016) at Memorial Hermann Hospital. RESULTS: We included 1141 injured adults. Two published preoperative appropriateness indications [a systolic blood pressure (BP) persistently <90 mmHg or core body temperature <34°C] produced moderate shifts in the pretest probability of conducting DC instead of definitive laparotomy. Five published intraoperative appropriateness indications produced large and often conclusive changes in the pretest probability of conducting DC during emergent laparotomy. These included the finding of a devascularized or completely disrupted pancreas, duodenum, or pancreaticoduodenal complex; an estimated intraoperative blood loss >4 L; administration of >10 U of packed red blood cells (PRBCs); and a systolic BP persistently <90 mmHg or arterial pH persistently <7.2 during operation. Most indications that produced large changes in the pretest probability of conducting DC laparotomy had an incidence of 2% or less. CONCLUSIONS: This study suggests that published appropriateness indications accurately predict use of DC laparotomy in practice. Intraoperative variables exert greater influence on the decision to conduct DC laparotomy than preoperative variables, and those indications that produce large shifts in the pretest probability of conducting DC laparotomy are uncommonly encountered.
Authors: Carlos A Ordoñez; Michael W Parra; Yaset Caicedo; Natalia Padilla; Edison Angamarca; José Julián Serna; Fernando Rodríguez-Holguín; Alberto García; Alexander Salcedo; Luis Fernando Pino; Adolfo González-Hadad; Mario Alain Herrera; Laureano Quintero; Fabian Hernández; María Josefa Franco; Gonzalo Aristizábal; Luis Eduardo Toro; Mónica Guzmán-Rodríguez; Federico Coccolini; Ricardo Ferrada; Rao Ivatury Journal: Colomb Med (Cali) Date: 2021-04-27
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