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Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy.

Abstract：

BACKGROUND:Failure to achieve primary fascial closure (PFC) after damage control laparotomy is costly and carries great morbidity. We hypothesized that time from the initial laparotomy to the first take-back operation would be predictive of successful PFC. METHODS:Trauma patients managed with open abdominal techniques after damage control laparotomy were prospectively followed at 14 Level 1 trauma centers during a 2-year period. Time to the first take-back was evaluated as a predictor of PFC using hierarchical multivariate logistic regression analysis. RESULTS:A total of 499 patients underwent damage control laparotomy and were included in this analysis. PFC was achieved in 327 (65.5%) patients. Median time to the first take-back operation was 36 hours (interquartile range 24-48). After we adjusted for patient demographics, resuscitation volumes, and operative characteristics, increasing time to the first take-back was associated with a decreased likelihood of PFC. Specifically, each hour delay in return to the operating room (24 hours after initial laparotomy) was associated with a 1.1% decrease in the odds of PFC (odds ratio 0.989; 95% confidence interval 0.978-0.999; P = .045). In addition, there was a trend towards increased intra-abdominal complications in patients returning after 48 hours (odds ratio 1.80; 95% confidence interval 1.00-3.25; P = .05). CONCLUSION:Data from this prospective, multicenter study demonstrate that delays in returning to the operating room after damage control laparotomy are associated with reductions in PFC. These findings suggest that emphasis should be placed on returning to the operating room within 24 hours after the initial laparotomy if possible (and no later than 48 hours).

journal_name

Surgery

journal_title

Surgery

authors

Pommerening MJ,DuBose JJ,Zielinski MD,Phelan HA,Scalea TM,Inaba K,Velmahos GC,Whelan JF,Wade CE,Holcomb JB,Cotton BA,AAST Open Abdomen Study Group.

doi

10.1016/j.surg.2014.04.019

subject

Has Abstract

pub_date

2014-08-01 00:00:00

pages

431-8

issue

eissn

0039-6060

issn

1532-7361

pii

S0039-6060(14)00189-5

journal_volume

156

pub_type

临床试验,杂志文章,多中心研究

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Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy.