Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun 15;6(1):e000706.
doi: 10.1136/tsaco-2021-000706. eCollection 2021.

Six-year national study of damage control laparotomy and the effect of repeat re-exploration on rate of infectious complications

Krislyn Foster  1 , James Yon  1 , Casey E Pelzl  2 , Kristin Salottolo  2 , Caleb Mentzer  3 , Glenda Quan  1 , Emmett E McGuire  1 , Burt Katubig  1 , David Bar-Or  1   2
Affiliations

Six-year national study of damage control laparotomy and the effect of repeat re-exploration on rate of infectious complications

Krislyn Foster et al. Trauma Surg Acute Care Open. .

Abstract

Background: Damage control laparotomy (DCL) is a life-saving procedure in patients with abdominal hemorrhage. After DCL, patients are sometimes left with an open abdomen (OA) so they may undergo multiple exploratory laparotomies (EXLAP), or re-explorations. Patients with OA are at increased risk of infectious complications (ICs). The association between number of re-explorations after DCL and the number of ICs is not clear. We hypothesized that each additional re-exploration increases the risk of developing IC.

Methods: This 6-year retrospective cohort study included patients aged ≥16 years from the NTDB who had DCL defined as EXLAP within 2 hours of arrival (ICD-9: 54.11, 54.12, 54.19) with at least one re-exploration. The primary outcome was IC (ie, superficial surgical site infection (SSI), organ space SSI, deep SSI, sepsis, pneumonia, or catheter-related bloodstream infection), examined dichotomously (present/absent) and ordinally as the number of ICs. Multivariate Poisson regression was used to assess the association between number of re-explorations and number of ICs. Significance was assigned at p<0.01.

Results: There were 7431 patients who underwent DCL; 2509 (34%) patients developed at least one IC. The rate of IC was lowest in patients who were closed during the first re-exploration (27%) and significantly increased with each re-exploration to 59% in patients who had five or more re-explorations (Cochran-Armitage trend p<0.001). After adjustment, there was 14% increased risk of an additional IC with each re-exploration (p<0.001).

Discussion: For patients requiring DCL, each re-exploration of the abdomen is associated with increased rate of ICs.

Level of evidence: III, retrospective epidemiological study.

Keywords: infections; laparotomy.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Histogram demonstrating rate (%) of an infectious complication by number of re-explorations.
Figure 2
Figure 2
Histogram demonstrating number of infectious complications by number of re-explorations. IC, infectious complication.
See this image and copyright information in PMC

References

    1. Wafaisade A, Lefering R, Bouillon B, Sakka SG, Thamm OC, Paffrath T, Neugebauer E, Maegele M, Trauma Registry of the German Society for Trauma Surgery . Epidemiology and risk factors of sepsis after multiple trauma: an analysis of 29,829 patients from the trauma registry of the German Society for trauma surgery. Crit Care Med 2011;39:621–8. 10.1097/CCM.0b013e318206d3df - DOI - PubMed
    1. Harvin JA, Wray CJ, Steward J, Lawless RA, McNutt MK, Love JD, Moore LJ, Wade CE, Cotton BA, Holcomb JB. Control the damage: morbidity and mortality after emergent trauma laparotomy. Am J Surg 2016;212:200–9. 10.1016/j.amjsurg.2015.10.014 - DOI - PubMed
    1. Hatch QM, Osterhout LM, Podbielski J, Kozar RA, Wade CE, Holcomb JB, Cotton BA. Impact of closure at the first take back: complication burden and potential overutilization of damage control laparotomy. J Trauma 2011;71:1503–11. 10.1097/TA.0b013e31823cd78d - DOI - PubMed
    1. Smith JW, Nash N, Procter L, Benns M, Franklin GA, Miller K, Harbrecht BG, Bernard AC. Not all abdomens are the same: a comparison of damage control surgery for intra-abdominal sepsis versus trauma. Am Surg 2016;82:427–32. 10.1177/000313481608200518 - DOI - PubMed
    1. Gundel O, Gundersen SK, Dahl RM, Jørgensen LN, Rasmussen LS, Wetterslev J, Sæbye D, Meyhoff CS. Timing of surgical site infection and pulmonary complications after laparotomy. Int J Surg 2018;52:56–60. 10.1016/j.ijsu.2018.02.022 - DOI - PubMed