Improving mortality in trauma laparotomy through the evolution of damage control resuscitation

Analysis of 1,030 consecutive trauma laparotomies

Bellal Joseph, Asad Azim, Bardiya Zangbar, Zachary Bauman, Terence OKeeffe, Kareem Ibraheem, Narong Kulvatunyou, Andrew Tang, Riaft Latifi, Peter Rhee

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

BACKGROUND: The aim of this study was to evaluate the related change in outcomes (mortality, complications) in patients undergoing trauma laparotomy (TL) with the implementation of damage control resuscitation (DCR). We hypothesized that the implementation of DCR in patients undergoing TL is associated with better outcomes. METHODS: We analyzed 1,030 consecutive patients with TL. Patients were stratified into three phases: pre-DCR (2006-2007), transient (2008-2009), and post-DCR (2010-2013). Resuscitation fluids (crystalloids and blood products), injury severity score (ISS), vital signs, and laboratory (hemoglobin, international normalized ratio, lactate) parameters were recorded. Regression analysis was performed after adjusting for age, ISS, laboratory and vital parameters, comorbidities, and resuscitation fluids to identify independent predictors for outcomes in each phase. RESULTS: Patient demographics and ISS remained the same throughout the three phases. There was a significant reduction in the volume of crystalloid (p = 0.001) and a concomitant increase in the blood product resuscitation (p = 0.04) in the post-DCR phase compared to the pre-DCR and transient DCR phases. Volume of crystalloid resuscitation was an independent predictor of mortality in the pre-DCR (OR [95% CI]: 1.071 [1.03-1.1], p = 0.01) and transient (OR [95% CI]: 1.05 [1.01-1.14], p = 0.01) phases; however, it was not associated with mortality in the post-DCR phase (OR [95% CI]:1.01 [0.96-1.09], p = 0.1). Coagulopathy (p = 0.01) and acidosis (p = 0.02) were independently associated with mortality in all three phases. CONCLUSION: The implementation of DCR was associated with improved outcome in patients undergoing TL. There was a decrease in the use of damage control laparotomy, with a decrease in the use of crystalloid and an increase in the use of blood products.

Original languageEnglish (US)
Pages (from-to)328-333
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume82
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Resuscitation
Laparotomy
Mortality
Wounds and Injuries
Injury Severity Score
International Normalized Ratio
Vital Signs
Acidosis
Comorbidity
Lactic Acid
Hemoglobins
Regression Analysis
Demography

Keywords

  • Damage control laparotomy
  • damage control resuscitation
  • outcomes
  • resuscitation
  • trauma laparotomy

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Improving mortality in trauma laparotomy through the evolution of damage control resuscitation : Analysis of 1,030 consecutive trauma laparotomies. / Joseph, Bellal; Azim, Asad; Zangbar, Bardiya; Bauman, Zachary; OKeeffe, Terence; Ibraheem, Kareem; Kulvatunyou, Narong; Tang, Andrew; Latifi, Riaft; Rhee, Peter.

In: Journal of Trauma and Acute Care Surgery, Vol. 82, No. 2, 01.02.2017, p. 328-333.

Research output: Contribution to journalArticle

Joseph, Bellal ; Azim, Asad ; Zangbar, Bardiya ; Bauman, Zachary ; OKeeffe, Terence ; Ibraheem, Kareem ; Kulvatunyou, Narong ; Tang, Andrew ; Latifi, Riaft ; Rhee, Peter. / Improving mortality in trauma laparotomy through the evolution of damage control resuscitation : Analysis of 1,030 consecutive trauma laparotomies. In: Journal of Trauma and Acute Care Surgery. 2017 ; Vol. 82, No. 2. pp. 328-333.
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abstract = "BACKGROUND: The aim of this study was to evaluate the related change in outcomes (mortality, complications) in patients undergoing trauma laparotomy (TL) with the implementation of damage control resuscitation (DCR). We hypothesized that the implementation of DCR in patients undergoing TL is associated with better outcomes. METHODS: We analyzed 1,030 consecutive patients with TL. Patients were stratified into three phases: pre-DCR (2006-2007), transient (2008-2009), and post-DCR (2010-2013). Resuscitation fluids (crystalloids and blood products), injury severity score (ISS), vital signs, and laboratory (hemoglobin, international normalized ratio, lactate) parameters were recorded. Regression analysis was performed after adjusting for age, ISS, laboratory and vital parameters, comorbidities, and resuscitation fluids to identify independent predictors for outcomes in each phase. RESULTS: Patient demographics and ISS remained the same throughout the three phases. There was a significant reduction in the volume of crystalloid (p = 0.001) and a concomitant increase in the blood product resuscitation (p = 0.04) in the post-DCR phase compared to the pre-DCR and transient DCR phases. Volume of crystalloid resuscitation was an independent predictor of mortality in the pre-DCR (OR [95{\%} CI]: 1.071 [1.03-1.1], p = 0.01) and transient (OR [95{\%} CI]: 1.05 [1.01-1.14], p = 0.01) phases; however, it was not associated with mortality in the post-DCR phase (OR [95{\%} CI]:1.01 [0.96-1.09], p = 0.1). Coagulopathy (p = 0.01) and acidosis (p = 0.02) were independently associated with mortality in all three phases. CONCLUSION: The implementation of DCR was associated with improved outcome in patients undergoing TL. There was a decrease in the use of damage control laparotomy, with a decrease in the use of crystalloid and an increase in the use of blood products.",
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T2 - Analysis of 1,030 consecutive trauma laparotomies

AU - Joseph, Bellal

AU - Azim, Asad

AU - Zangbar, Bardiya

AU - Bauman, Zachary

AU - OKeeffe, Terence

AU - Ibraheem, Kareem

AU - Kulvatunyou, Narong

AU - Tang, Andrew

AU - Latifi, Riaft

AU - Rhee, Peter

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N2 - BACKGROUND: The aim of this study was to evaluate the related change in outcomes (mortality, complications) in patients undergoing trauma laparotomy (TL) with the implementation of damage control resuscitation (DCR). We hypothesized that the implementation of DCR in patients undergoing TL is associated with better outcomes. METHODS: We analyzed 1,030 consecutive patients with TL. Patients were stratified into three phases: pre-DCR (2006-2007), transient (2008-2009), and post-DCR (2010-2013). Resuscitation fluids (crystalloids and blood products), injury severity score (ISS), vital signs, and laboratory (hemoglobin, international normalized ratio, lactate) parameters were recorded. Regression analysis was performed after adjusting for age, ISS, laboratory and vital parameters, comorbidities, and resuscitation fluids to identify independent predictors for outcomes in each phase. RESULTS: Patient demographics and ISS remained the same throughout the three phases. There was a significant reduction in the volume of crystalloid (p = 0.001) and a concomitant increase in the blood product resuscitation (p = 0.04) in the post-DCR phase compared to the pre-DCR and transient DCR phases. Volume of crystalloid resuscitation was an independent predictor of mortality in the pre-DCR (OR [95% CI]: 1.071 [1.03-1.1], p = 0.01) and transient (OR [95% CI]: 1.05 [1.01-1.14], p = 0.01) phases; however, it was not associated with mortality in the post-DCR phase (OR [95% CI]:1.01 [0.96-1.09], p = 0.1). Coagulopathy (p = 0.01) and acidosis (p = 0.02) were independently associated with mortality in all three phases. CONCLUSION: The implementation of DCR was associated with improved outcome in patients undergoing TL. There was a decrease in the use of damage control laparotomy, with a decrease in the use of crystalloid and an increase in the use of blood products.

AB - BACKGROUND: The aim of this study was to evaluate the related change in outcomes (mortality, complications) in patients undergoing trauma laparotomy (TL) with the implementation of damage control resuscitation (DCR). We hypothesized that the implementation of DCR in patients undergoing TL is associated with better outcomes. METHODS: We analyzed 1,030 consecutive patients with TL. Patients were stratified into three phases: pre-DCR (2006-2007), transient (2008-2009), and post-DCR (2010-2013). Resuscitation fluids (crystalloids and blood products), injury severity score (ISS), vital signs, and laboratory (hemoglobin, international normalized ratio, lactate) parameters were recorded. Regression analysis was performed after adjusting for age, ISS, laboratory and vital parameters, comorbidities, and resuscitation fluids to identify independent predictors for outcomes in each phase. RESULTS: Patient demographics and ISS remained the same throughout the three phases. There was a significant reduction in the volume of crystalloid (p = 0.001) and a concomitant increase in the blood product resuscitation (p = 0.04) in the post-DCR phase compared to the pre-DCR and transient DCR phases. Volume of crystalloid resuscitation was an independent predictor of mortality in the pre-DCR (OR [95% CI]: 1.071 [1.03-1.1], p = 0.01) and transient (OR [95% CI]: 1.05 [1.01-1.14], p = 0.01) phases; however, it was not associated with mortality in the post-DCR phase (OR [95% CI]:1.01 [0.96-1.09], p = 0.1). Coagulopathy (p = 0.01) and acidosis (p = 0.02) were independently associated with mortality in all three phases. CONCLUSION: The implementation of DCR was associated with improved outcome in patients undergoing TL. There was a decrease in the use of damage control laparotomy, with a decrease in the use of crystalloid and an increase in the use of blood products.

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