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Damage control operations in non-trauma patients: Defining criteria for the staged rapid source control laparotomy in emergency general surgery

Becher, RD and Peitzman, AB and Sperry, JL and Gallaher, JR and Neff, LP and Sun, Y and Miller, PR and Chang, MC (2016) Damage control operations in non-trauma patients: Defining criteria for the staged rapid source control laparotomy in emergency general surgery. World Journal of Emergency Surgery, 11 (1).

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Abstract

© 2016 Becher et al. Background: The staged laparotomy in the operative management of emergency general surgery (EGS) patients is an extension of trauma surgeons operating on this population. Indications for its application, however, are not well defined, and are currently based on the lethal triad used in physiologically-decompensated trauma patients. This study sought to determine the acute indications for the staged, rapid source control laparotomy (RSCL) in EGS patients. Methods: All EGS patients undergoing emergent staged RSCL and non-RSCL over 3years were studied. Demographics, physiologic parameters, perioperative variables, outcomes, and survival were compared. Logistic regression models determined the influence of physiologic parameters on mortality and postoperative complications. EGS-RSCL indications were defined. Results: 215 EGS patients underwent emergent laparotomy; 53 (25%) were staged RSCL. In the 53 patients who underwent a staged RSCL based on the lethal triad, adjusted multivariable regression analysis shows that when used alone, no component of the lethal triad independently improved survival. Staged RSCL may decrease mortality in patients with preoperative severe sepsis / septic shock, and an elevated lactate (≥3); acidosis (pH ≤ 7.25); elderly (≥70); male gender; and multiple comorbidities (≥3). Of the 162 non-RSCL emergent laparotomies, 27 (17%) required unplanned re-explorations; of these, 17 (63%) had sepsis preoperatively and 9 (33%) died. Conclusions: The acute physiologic indicators that help guide operative decisions in trauma may not confer a similar survival advantage in EGS. To replace the lethal triad, criteria for application of the staged RSCL in EGS need to be defined. Based on these results, the indications should include severe sepsis / septic shock, lactate, acidosis, gender, age, and pre-existing comorbidities. When correctly applied, the staged RSCL may help to improve survival in decompensated EGS patients.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Becher, RD
Peitzman, AB
Sperry, JLjls202@pitt.eduJLS202
Gallaher, JR
Neff, LP
Sun, Y
Miller, PR
Chang, MC
Date: 24 February 2016
Date Type: Publication
Journal or Publication Title: World Journal of Emergency Surgery
Volume: 11
Number: 1
DOI or Unique Handle: 10.1186/s13017-016-0067-4
Schools and Programs: School of Medicine > Surgery
Refereed: Yes
Date Deposited: 22 Aug 2016 18:46
Last Modified: 13 Oct 2017 21:57
URI: http://d-scholarship.pitt.edu/id/eprint/28731

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