The Experts below are selected from a list of 336126 Experts worldwide ranked by ideXlab platform
Ernest E Moore - One of the best experts on this subject based on the ideXlab platform.
-
history of the innovation of Damage Control for management of trauma patients 1902 2016
Annals of Surgery, 2017Co-Authors: Derek J Roberts, David A Zygun, Ernest E Moore, Andrew W Kirkpatrick, Chad G Ball, Timothy C Fabian, Rao R Ivatury, David V Feliciano, Charles E Lucas, Henry T StelfoxAbstract:Objective:To review the history of the innovation of Damage Control (DC) for management of trauma patients.Background:DC is an important development in trauma care that provides a valuable case study in surgical innovation.Methods:We searched bibliographic databases (1950–2015), conference abstracts
-
principles and philosophy of Damage Control surgery
2014Co-Authors: Fredric M. Pieracci, Ernest E MooreAbstract:The term “Damage Control” refers to a specific approach to the exsanguinating trauma patient. Central to the approach is the recognition that the cold, acidotic, hemorrhaging trauma patient bleeds to death as a result of diffuse coagulopathy as opposed to mechanical surgical bleeding. As such, when patients either are expected to develop or have already developed diffuse coagulopathy in the setting of hemorrhagic shock, the Damage Control sequence is initiated. The sequence involves an initial abbreviated laparotomy, the goal of which is to preserve life. The operation proceeds rapidly and in the following order: Control of hemorrhage, Control of gastrointestinal contamination, and temporary abdominal closure to prevent further blood, protein, and heat loss. Methods to achieve emergent hemorrhage Control, as well as factors that contribute to the decision to terminate the operation, are discussed herein. The next stages of Damage Control occur over the subsequent days to weeks and involve resuscitation in the intensive care unit, return to the operating room for definitive repair of injuries, avoidance of abdominal compartment syndrome, and ultimate fascial closure. The Damage Control approach has revolutionized the care of the sickest trauma patients; an understanding of the nuances of the various stages is essential for any trauma surgeon.
-
effect of Damage Control surgery on major abdominal vascular trauma
Journal of Surgical Research, 2012Co-Authors: Talia A Sorrentino, Max Wohlauer, Walter L Biffl, Fredric M. Pieracci, Ernest E Moore, Jeffrey L JohnsonAbstract:Background: In 1982, we reported our experience with abdominal vascular trauma, highlighting the critical role of hypothermia, acidosis, and coagulopathy. Damage Control surgery was subsequently introduced to address this “lethal triad.” The purpose of the present study was to evaluate the outcomes from our most recent 6-year experience compared with a cohort from 30 years ago. Methods: Patients with major abdominal vascular injuries were examined, and the most recent 6-year period was compared with archived data from a similar 6-year period three decades ago. Results: The number of patients with major abdominal vascular injuries decreased from 123 patients in 1975 to 1980 to 64 patients in 2004 to 2009. The mean initial pH decreased from 7.21 to 6.96 (1975 to 1980 versus 2004 to 2009) for patients with overt coagulopathy. Despite increasingly protracted acidosis, mortality attributable to refractory coagulopathy decreased from 46% to 19% (1975 to 1980 versus 2004 to 2009, chi-square ¼ 4.36, P ¼ 0.04). No significant difference was found in mortality from exsanguinating injuries (43% versus 62%, 1975 to 1980 versus 2004 to 2009, chi-square ¼ 1.96, P ¼ 0.16). The prehospital transport times were unchanged (22 versus 20 min, 1975 to 1980 versus 2004 to 2009). Despite the administration of additional clotting factors and the advent of Damage Control surgery, the overall mortality remained largely unchanged (37% versus 33%, 1975 to 1980 versus 2004 to 2009, chi-square ¼ 0.385, P ¼ 0.53). Conclusions: The adoption of Damage Control surgery, including the implementation of a massive transfusion protocol, was associated with a reduction in mortality for abdominal vascular injuries due to coagulopathy; however, patients have continued to die of exsanguination.
-
association for academic surgeryeffect of Damage Control surgery on major abdominal vascular trauma
Journal of Surgical Research, 2012Co-Authors: Talia A Sorrentino, Max Wohlauer, Jeffrey L Johnson, Denis D Bensard, Walter L Biffl, Carlton C Barnett, Fredric M. Pieracci, Ernest E Moore, Clay Cothren BurlewAbstract:Background In 1982, we reported our experience with abdominal vascular trauma, highlighting the critical role of hypothermia, acidosis, and coagulopathy. Damage Control surgery was subsequently introduced to address this “lethal triad.” The purpose of the present study was to evaluate the outcomes from our most recent 6-year experience compared with a cohort from 30 years ago.
-
avoidance of abdominal compartment syndrome in Damage Control laparotomy after trauma
Archives of Surgery, 2001Co-Authors: Patrick J Offner, Jeffrey L Johnson, Walter L Biffl, Ernest E Moore, Almerindo Laurence De Souza, Reginald J Franciose, Jon M BurchAbstract:Hypothesis Abdominal compartment syndrome (ACS) is a morbid complication of Damage-Control laparotomy. Moreover, the technique of abdominal closure influences the frequency of ACS. Design Retrospective cohort study. Setting Urban level I trauma center. Patients We studied 52 patients with trauma who required Damage-Control laparotomy during the 5 years ending December 31, 1999, and who survived longer than 48 hours. Main Outcome Measures Abdominal compartment syndrome, acute respiratory distress syndrome (ARDS), and multiple organ failure (MOF). Results Mean (± SD) age was 33 ± 2 years; 38 (73%) were male. Mechanism of injury was blunt in 29 patients (56%), and mean (± SD) Injury Severity Score was 28 ± 2. Development of ARDS and/or MOF was seen in 23 patients (44%); ARDS and MOF increased mortality from 12% (3/26) to 42% (11/26). Abdominal compartment syndrome was a common complication (17/52), and was associated with an increase in ARDS and/or MOF (12 patients [71%] vs 11 patients [31%] without ACS;P= .02, χ2test) and death (6 [35%] vs 8 patients [23%] without ACS). Primary fascial closure (n = 10) at the initial laparotomy was associated with ACS in 8 (80%) (P= .001, χ2test) and ARDS and/or MOF in 9 (90%) (P= .01, χ2test); skin closure (n = 25), with ACS in 6 (24%) and ARDS/MOF in 9 (36%); and Bogota bag closure (n = 17), with ACS in 3 (18%) and ARDS/MOF in 8 (47%). Conclusions Damage-Control laparotomy is associated with frequent complications. In particular, ACS is a serious complication that increases ARDS and/or MOF and mortality. Avoiding primary fascial closure at the initial laparotomy can minimize the risk for ACS.
Jeffrey L Johnson - One of the best experts on this subject based on the ideXlab platform.
-
effect of Damage Control surgery on major abdominal vascular trauma
Journal of Surgical Research, 2012Co-Authors: Talia A Sorrentino, Max Wohlauer, Walter L Biffl, Fredric M. Pieracci, Ernest E Moore, Jeffrey L JohnsonAbstract:Background: In 1982, we reported our experience with abdominal vascular trauma, highlighting the critical role of hypothermia, acidosis, and coagulopathy. Damage Control surgery was subsequently introduced to address this “lethal triad.” The purpose of the present study was to evaluate the outcomes from our most recent 6-year experience compared with a cohort from 30 years ago. Methods: Patients with major abdominal vascular injuries were examined, and the most recent 6-year period was compared with archived data from a similar 6-year period three decades ago. Results: The number of patients with major abdominal vascular injuries decreased from 123 patients in 1975 to 1980 to 64 patients in 2004 to 2009. The mean initial pH decreased from 7.21 to 6.96 (1975 to 1980 versus 2004 to 2009) for patients with overt coagulopathy. Despite increasingly protracted acidosis, mortality attributable to refractory coagulopathy decreased from 46% to 19% (1975 to 1980 versus 2004 to 2009, chi-square ¼ 4.36, P ¼ 0.04). No significant difference was found in mortality from exsanguinating injuries (43% versus 62%, 1975 to 1980 versus 2004 to 2009, chi-square ¼ 1.96, P ¼ 0.16). The prehospital transport times were unchanged (22 versus 20 min, 1975 to 1980 versus 2004 to 2009). Despite the administration of additional clotting factors and the advent of Damage Control surgery, the overall mortality remained largely unchanged (37% versus 33%, 1975 to 1980 versus 2004 to 2009, chi-square ¼ 0.385, P ¼ 0.53). Conclusions: The adoption of Damage Control surgery, including the implementation of a massive transfusion protocol, was associated with a reduction in mortality for abdominal vascular injuries due to coagulopathy; however, patients have continued to die of exsanguination.
-
association for academic surgeryeffect of Damage Control surgery on major abdominal vascular trauma
Journal of Surgical Research, 2012Co-Authors: Talia A Sorrentino, Max Wohlauer, Jeffrey L Johnson, Denis D Bensard, Walter L Biffl, Carlton C Barnett, Fredric M. Pieracci, Ernest E Moore, Clay Cothren BurlewAbstract:Background In 1982, we reported our experience with abdominal vascular trauma, highlighting the critical role of hypothermia, acidosis, and coagulopathy. Damage Control surgery was subsequently introduced to address this “lethal triad.” The purpose of the present study was to evaluate the outcomes from our most recent 6-year experience compared with a cohort from 30 years ago.
-
avoidance of abdominal compartment syndrome in Damage Control laparotomy after trauma
Archives of Surgery, 2001Co-Authors: Patrick J Offner, Jeffrey L Johnson, Walter L Biffl, Ernest E Moore, Almerindo Laurence De Souza, Reginald J Franciose, Jon M BurchAbstract:Hypothesis Abdominal compartment syndrome (ACS) is a morbid complication of Damage-Control laparotomy. Moreover, the technique of abdominal closure influences the frequency of ACS. Design Retrospective cohort study. Setting Urban level I trauma center. Patients We studied 52 patients with trauma who required Damage-Control laparotomy during the 5 years ending December 31, 1999, and who survived longer than 48 hours. Main Outcome Measures Abdominal compartment syndrome, acute respiratory distress syndrome (ARDS), and multiple organ failure (MOF). Results Mean (± SD) age was 33 ± 2 years; 38 (73%) were male. Mechanism of injury was blunt in 29 patients (56%), and mean (± SD) Injury Severity Score was 28 ± 2. Development of ARDS and/or MOF was seen in 23 patients (44%); ARDS and MOF increased mortality from 12% (3/26) to 42% (11/26). Abdominal compartment syndrome was a common complication (17/52), and was associated with an increase in ARDS and/or MOF (12 patients [71%] vs 11 patients [31%] without ACS;P= .02, χ2test) and death (6 [35%] vs 8 patients [23%] without ACS). Primary fascial closure (n = 10) at the initial laparotomy was associated with ACS in 8 (80%) (P= .001, χ2test) and ARDS and/or MOF in 9 (90%) (P= .01, χ2test); skin closure (n = 25), with ACS in 6 (24%) and ARDS/MOF in 9 (36%); and Bogota bag closure (n = 17), with ACS in 3 (18%) and ARDS/MOF in 8 (47%). Conclusions Damage-Control laparotomy is associated with frequent complications. In particular, ACS is a serious complication that increases ARDS and/or MOF and mortality. Avoiding primary fascial closure at the initial laparotomy can minimize the risk for ACS.
Walter L Biffl - One of the best experts on this subject based on the ideXlab platform.
-
effect of Damage Control surgery on major abdominal vascular trauma
Journal of Surgical Research, 2012Co-Authors: Talia A Sorrentino, Max Wohlauer, Walter L Biffl, Fredric M. Pieracci, Ernest E Moore, Jeffrey L JohnsonAbstract:Background: In 1982, we reported our experience with abdominal vascular trauma, highlighting the critical role of hypothermia, acidosis, and coagulopathy. Damage Control surgery was subsequently introduced to address this “lethal triad.” The purpose of the present study was to evaluate the outcomes from our most recent 6-year experience compared with a cohort from 30 years ago. Methods: Patients with major abdominal vascular injuries were examined, and the most recent 6-year period was compared with archived data from a similar 6-year period three decades ago. Results: The number of patients with major abdominal vascular injuries decreased from 123 patients in 1975 to 1980 to 64 patients in 2004 to 2009. The mean initial pH decreased from 7.21 to 6.96 (1975 to 1980 versus 2004 to 2009) for patients with overt coagulopathy. Despite increasingly protracted acidosis, mortality attributable to refractory coagulopathy decreased from 46% to 19% (1975 to 1980 versus 2004 to 2009, chi-square ¼ 4.36, P ¼ 0.04). No significant difference was found in mortality from exsanguinating injuries (43% versus 62%, 1975 to 1980 versus 2004 to 2009, chi-square ¼ 1.96, P ¼ 0.16). The prehospital transport times were unchanged (22 versus 20 min, 1975 to 1980 versus 2004 to 2009). Despite the administration of additional clotting factors and the advent of Damage Control surgery, the overall mortality remained largely unchanged (37% versus 33%, 1975 to 1980 versus 2004 to 2009, chi-square ¼ 0.385, P ¼ 0.53). Conclusions: The adoption of Damage Control surgery, including the implementation of a massive transfusion protocol, was associated with a reduction in mortality for abdominal vascular injuries due to coagulopathy; however, patients have continued to die of exsanguination.
-
association for academic surgeryeffect of Damage Control surgery on major abdominal vascular trauma
Journal of Surgical Research, 2012Co-Authors: Talia A Sorrentino, Max Wohlauer, Jeffrey L Johnson, Denis D Bensard, Walter L Biffl, Carlton C Barnett, Fredric M. Pieracci, Ernest E Moore, Clay Cothren BurlewAbstract:Background In 1982, we reported our experience with abdominal vascular trauma, highlighting the critical role of hypothermia, acidosis, and coagulopathy. Damage Control surgery was subsequently introduced to address this “lethal triad.” The purpose of the present study was to evaluate the outcomes from our most recent 6-year experience compared with a cohort from 30 years ago.
-
avoidance of abdominal compartment syndrome in Damage Control laparotomy after trauma
Archives of Surgery, 2001Co-Authors: Patrick J Offner, Jeffrey L Johnson, Walter L Biffl, Ernest E Moore, Almerindo Laurence De Souza, Reginald J Franciose, Jon M BurchAbstract:Hypothesis Abdominal compartment syndrome (ACS) is a morbid complication of Damage-Control laparotomy. Moreover, the technique of abdominal closure influences the frequency of ACS. Design Retrospective cohort study. Setting Urban level I trauma center. Patients We studied 52 patients with trauma who required Damage-Control laparotomy during the 5 years ending December 31, 1999, and who survived longer than 48 hours. Main Outcome Measures Abdominal compartment syndrome, acute respiratory distress syndrome (ARDS), and multiple organ failure (MOF). Results Mean (± SD) age was 33 ± 2 years; 38 (73%) were male. Mechanism of injury was blunt in 29 patients (56%), and mean (± SD) Injury Severity Score was 28 ± 2. Development of ARDS and/or MOF was seen in 23 patients (44%); ARDS and MOF increased mortality from 12% (3/26) to 42% (11/26). Abdominal compartment syndrome was a common complication (17/52), and was associated with an increase in ARDS and/or MOF (12 patients [71%] vs 11 patients [31%] without ACS;P= .02, χ2test) and death (6 [35%] vs 8 patients [23%] without ACS). Primary fascial closure (n = 10) at the initial laparotomy was associated with ACS in 8 (80%) (P= .001, χ2test) and ARDS and/or MOF in 9 (90%) (P= .01, χ2test); skin closure (n = 25), with ACS in 6 (24%) and ARDS/MOF in 9 (36%); and Bogota bag closure (n = 17), with ACS in 3 (18%) and ARDS/MOF in 8 (47%). Conclusions Damage-Control laparotomy is associated with frequent complications. In particular, ACS is a serious complication that increases ARDS and/or MOF and mortality. Avoiding primary fascial closure at the initial laparotomy can minimize the risk for ACS.
John B Holcomb - One of the best experts on this subject based on the ideXlab platform.
-
time to first take back operation predicts successful primary fascial closure in patients undergoing Damage Control laparotomy
Surgery, 2014Co-Authors: Matthew J Pommerening, Joseph J Dubose, Thomas M Scalea, Kenji Inaba, James Whelan, George C Velmahos, Martin D Zielinski, Herb A Phelan, Charles E Wade, John B HolcombAbstract: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).
-
independent predictors of enteric fistula and abdominal sepsis after Damage Control laparotomy results from the prospective aast open abdomen registry
JAMA Surgery, 2013Co-Authors: Matthew J Bradley, John B Holcomb, Joseph J Dubose, Thomas M Scalea, Binod Shrestha, Obi Okoye, Kenji Inaba, Tiffany K Bee, Timothy C Fabian, James WhelanAbstract:Importance Enterocutaneous fistula (ECF), enteroatmospheric fistula (EAF), and intra-abdominal sepsis/abscess (IAS) are major challenges for surgeons caring for patients undergoing Damage Control laparotomy after trauma. Objective To determine independent predictors of ECF, EAF, or IAS in patients undergoing Damage Control laparotomy after trauma, using the AAST Open Abdomen Registry. Design The AAST Open Abdomen registry of patients with an open abdomen following Damage Control laparotomy was used to identify patients who developed ECF, EAF, or IAS and to compare these patients with those without these complications. Univariate analyses were performed to compare these groups of patients. Variables from univariate analyses differing at P Setting Fourteen level I trauma centers. Participants A total of 517 patients with an open abdomen following Damage Control laparotomy. Main outcomes and measures Complication of ECF, EAF, or IAS. Results More patients in the ECF/EAF/IAS group than in the group without these complications underwent bowel resection (63 of 111 patients [57%] vs 133 of 406 patients [33%]; P Conclusions and relevance Large bowel resection, large-volume fluid resuscitation, and an increasing number of abdominal reexplorations were statistically significant predictors of ECF, EAF, or IAS in patients with an open abdomen after Damage Control laparotomy.
-
Damage Control resuscitation addressing trauma induced coagulopathy
British Journal of Hospital Medicine, 2009Co-Authors: Juan Duchesne, John B HolcombAbstract:Damage Control resuscitation attempts early, aggressive correction of trauma-induced coagulopathy in conjunction with interventions designed to achieve early surgical haemostasis and Control of contamination. This article reviews the basis of Damage Control resuscitation and looks at implications for optimizing prognosis after trauma.
-
Damage Control resuscitation for vascular surgery in a combat support hospital
Journal of Trauma-injury Infection and Critical Care, 2008Co-Authors: David L Gillespie, Sumeru G Mehta, John F Kragh, Jose Salinas, John B HolcombAbstract:Background: Hemorrhage from extremity wounds is a leading cause of potentially preventable death during modem combat operations. Optimal management involves rapid hemostasis and reversal of metabolic derangements utilizing Damage Control principles. The traditional practice of Damage Control surgery favors a life over limb approach and discourages elaborate, prolonged vascular reconstructions. We hypothesized that limb preservation could be successful when the Damage Control approach combines advanced resuscitative strategies and modern vascular techniques. Methods: Trauma Registry records at a Combat Support Hospital from April to June 2006 were retrospectively reviewed. Patients with life-threatening hemorrhage (defined as >4 units of packed red blood cells) who underwent simultaneous revascularization for a pulseless extremity were included. Data collection included the initial physiologic parameters in the emergency department (ED), total and 24-hour blood product requirements, and admission physiology and laboratory values in the intensive care unit (ICU). Outcome measures were survival, graft patency, and amputation rate at 7 days. Results: Sixteen patients underwent 20 vascular reconstructions for upper (3) or lower extremity (17) wounds. Patients were hypotensive (blood pressure 105/ 60 ± 29/18), acidotic (pH 7.27 ± 0.1; BD -7.50 ± 5.5), and coagulopathic (international normalized ratio 1.3 ± 0.4) on arrival to the ED and essentially normal upon admission to the ICU, 4 hours later. Vein grafts (19/20, 95%) were used preferentially. Prosthetic grafts (1), shunting and delayed repair (4) or amputation (1) were infrequent. Heparin was not used or limited to a half dose (5/20, 25%). Tourniquets (12/16, 75%) and fasciotomies (13/16, 81%) were routine. Most (75%) received recombinant factor VIIa in the ED and in the operating room. All survived with normalized physiology on arrival in the ICU. Twenty-four-hour crystalloid use averaged 7.1 ± 3.2 L, whereas packed red blood cells averaged 23 ± 18 units, and 88% were massively transfused. Median operative time was 45 hours (range, 1.7-8.4 hours). Conclusions: Aggressive Damage Control resuscitation maneuvers in critically injured casualties successfully permitted prolonged, complex extremity revascularization with excellent early limb salvage and graft patency. Recombinant VIIa and liberal resuscitation with fresh whole blood, plasma, platelets and cryoprecipitate, while minimizing crystalloid, allowed limb salvage and did not result in early graft failures.
-
Damage Control resuscitation directly addressing the early coagulopathy of trauma
Journal of Trauma-injury Infection and Critical Care, 2007Co-Authors: John B Holcomb, Martin A Schreiber, Don Jenkins, Peter M Rhee, Jay A Johannigman, Peter F Mahoney, Sumeru G Mehta, Michael J Gehrke, Gregory J Beilman, Stephen F FlahertyAbstract:Abstract : Rapid progress in trauma care occurs when the results of translational research are promptly integrated into clinical practice. Experience with a high volume of severely injured casualties expedites the process. Historically, these conditions have converged during times of conflict, improving the care of combat casualties and subsequently that of civilian trauma patients. In the most severely injured casualties, we know that when the lethal triad of hypothermia, acidosis, and coagulopathy are present, death is imminent. Current teaching is to avoid reaching these conditions by using Damage Control surgery. However, conventional resuscitation practice for Damage Control focuses on rapid reversal of acidosis and prevention of hypothermia, and surgical techniques focus on Controlling hemorrhage and contamination. Direct treatment of coagulopathy has been relatively neglected, viewed as a byproduct of resuscitation, hemodilution, and hypothermia, and delayed by blood banking logistics. Damage Control resuscitation addresses the entire lethal triad immediately upon admission to a combat hospital. By demonstrating that in the severely injured the coagulopathy of trauma is present at admission, recent studies have brought back to light the importance of treating this disorder at an earlier stage. Reports of lactated Ringer s solution and normal saline increasing reperfusion injury and leukocyte adhesion lead one to conclude that the standard crystalloid based resuscitation guidelines in pre hospital trauma life support (PHTLS) and advanced trauma life support (ATLS) may worsen the presenting acidosis and coagulopathy in severely injured trauma patients, and possibly increase ARDS, SIRS, and MOF. The safety of withholding PRBCs in hemodynamically stable patients has been demonstrated,18 and the risks associated with blood transfusion are well described.
Joseph J Dubose - One of the best experts on this subject based on the ideXlab platform.
-
rotational thromboelastometry significantly optimizes transfusion practices for Damage Control resuscitation in combat casualties
Journal of Trauma-injury Infection and Critical Care, 2017Co-Authors: Nicolas Prat, Joseph J Dubose, Andrew Meyer, Nichole K Ingalls, Julie Trichereau, Andrew P CapAbstract:BACKGROUNDUp to 40% of combat casualties with a truncal injury die of massive hemorrhage before reaching a surgeon. This hemorrhage can be prevented with Damage Control resuscitation (DCR) methods, which are focused on replacing shed whole blood by empirically transfusing blood components in a 1:1:1
-
Damage Control thoracic surgery management and outcomes
Journal of Trauma-injury Infection and Critical Care, 2014Co-Authors: James V Oconnor, Joseph J Dubose, Thomas M ScaleaAbstract:BACKGROUNDDamage-Control surgery is successfully used for severe abdominal trauma. Although the Damage-Control surgery principles are applicable to thoracic trauma, there is a dearth of data on Damage-Control thoracic surgery.METHODSThis is an institutional review board–approved, retrospective traum
-
time to first take back operation predicts successful primary fascial closure in patients undergoing Damage Control laparotomy
Surgery, 2014Co-Authors: Matthew J Pommerening, Joseph J Dubose, Thomas M Scalea, Kenji Inaba, James Whelan, George C Velmahos, Martin D Zielinski, Herb A Phelan, Charles E Wade, John B HolcombAbstract: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).
-
independent predictors of enteric fistula and abdominal sepsis after Damage Control laparotomy results from the prospective aast open abdomen registry
JAMA Surgery, 2013Co-Authors: Matthew J Bradley, John B Holcomb, Joseph J Dubose, Thomas M Scalea, Binod Shrestha, Obi Okoye, Kenji Inaba, Tiffany K Bee, Timothy C Fabian, James WhelanAbstract:Importance Enterocutaneous fistula (ECF), enteroatmospheric fistula (EAF), and intra-abdominal sepsis/abscess (IAS) are major challenges for surgeons caring for patients undergoing Damage Control laparotomy after trauma. Objective To determine independent predictors of ECF, EAF, or IAS in patients undergoing Damage Control laparotomy after trauma, using the AAST Open Abdomen Registry. Design The AAST Open Abdomen registry of patients with an open abdomen following Damage Control laparotomy was used to identify patients who developed ECF, EAF, or IAS and to compare these patients with those without these complications. Univariate analyses were performed to compare these groups of patients. Variables from univariate analyses differing at P Setting Fourteen level I trauma centers. Participants A total of 517 patients with an open abdomen following Damage Control laparotomy. Main outcomes and measures Complication of ECF, EAF, or IAS. Results More patients in the ECF/EAF/IAS group than in the group without these complications underwent bowel resection (63 of 111 patients [57%] vs 133 of 406 patients [33%]; P Conclusions and relevance Large bowel resection, large-volume fluid resuscitation, and an increasing number of abdominal reexplorations were statistically significant predictors of ECF, EAF, or IAS in patients with an open abdomen after Damage Control laparotomy.
