Carlos A Ordoñez1,2, Michael Parra3, Alberto García4,5, Fernando Rodríguez4, Yaset Caicedo6, José Julián Serna4,5, Alexander Salcedo4,5, Josefa Franco4, Luis Eduardo Toro4, Juliana Ordoñez5, Luis Fernando Pino5, Mónica Guzmán6, Claudia Orlas7, Juan Pablo Herrera7, Gonzalo Aristizábal4, Francesco Pata8,9, Salomone Di Saverio10. 1. Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18 - 49, Cali, 760032, Colombia. ordonezcarlosa@gmail.com. 2. Sección de Cirugía de Trauma Y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cali, Colombia. ordonezcarlosa@gmail.com. 3. Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL, USA. 4. Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18 - 49, Cali, 760032, Colombia. 5. Sección de Cirugía de Trauma Y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cali, Colombia. 6. Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cra 98 No. 18 - 49, Cali, 760032, Colombia. 7. Center for Surgery and Public Health, Department of Surgery, Harvard Medical School & Harvard T.H. Chan School of Public Health, Brigham & Women's Hospital, Boston, MA, USA. 8. Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy. 9. La Sapienza University, Rome, Italy. 10. Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Abstract
BACKGROUND: Damage control surgery (DCS) has emerged as a new option in the management of non-traumatic peritonitis patients to increase survival in critically ill patients. The purpose of this study was to compare DCS with conventional strategy (anastomosis/ostomies in the index laparotomy) for severe non-traumatic peritonitis regarding postoperative complications, ostomy rate, and mortality and to propose a useful algorithm in the clinical practice. METHODS: Patients who underwent an urgent laparotomy for non-trauma peritonitis at a single level I trauma center in Colombia between January 2003 and December 2018, were retrospectively included. We compared patients who had DCS management versus definitive initial surgical management (DISM) group. We evaluated clinical outcomes and morbidities among groups. RESULTS: 290 patients were included; 81 patients were treated with DCS and 209 patients underwent DISM. Patients treated with DCS had a worse critical status before surgery with higher SOFA score [median, DCS group: 5 (IQR: 3-8) vs. DISM group: 3 (IQR: 1-6), p < 0.001]. The length of hospital stay and overall mortality rate of DCS group were not significant statistical differences with DISM group. Complications rate related to primary anastomosis or primary ostomy was similar. There is not difference in ostomy rate among groups. At multivariate analysis, SOFA > 6 points and APACHE-II > 20 points correlated with a higher probability of DCS. CONCLUSION: DCS in severe non-trauma peritonitis patients is feasible and safe as surgical strategy management without increasing mortality, length hospital of stay, or complications. DCS principles might be applied in the non-trauma scenarios without increase the stoma rate.
BACKGROUND: Damage control surgery (DCS) has emerged as a new option in the management of non-traumatic peritonitispatients to increase survival in critically illpatients. The purpose of this study was to compare DCS with conventional strategy (anastomosis/ostomies in the index laparotomy) for severe non-traumatic peritonitis regarding postoperative complications, ostomy rate, and mortality and to propose a useful algorithm in the clinical practice. METHODS:Patients who underwent an urgent laparotomy for non-trauma peritonitis at a single level I trauma center in Colombia between January 2003 and December 2018, were retrospectively included. We compared patients who had DCS management versus definitive initial surgical management (DISM) group. We evaluated clinical outcomes and morbidities among groups. RESULTS: 290 patients were included; 81 patients were treated with DCS and 209 patients underwent DISM. Patients treated with DCS had a worse critical status before surgery with higher SOFA score [median, DCS group: 5 (IQR: 3-8) vs. DISM group: 3 (IQR: 1-6), p < 0.001]. The length of hospital stay and overall mortality rate of DCS group were not significant statistical differences with DISM group. Complications rate related to primary anastomosis or primary ostomy was similar. There is not difference in ostomy rate among groups. At multivariate analysis, SOFA > 6 points and APACHE-II > 20 points correlated with a higher probability of DCS. CONCLUSION:DCS in severe non-trauma peritonitispatients is feasible and safe as surgical strategy management without increasing mortality, length hospital of stay, or complications. DCS principles might be applied in the non-trauma scenarios without increase the stoma rate.
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