Improving mortality in trauma laparotomy through the evolution of damage control resuscitation: Analysis of 1,030 consecutive trauma laparotomies.

Background: The aim of this study was to evaluate the related change in outcomes (mortality, complications) in patients undergoing trauma laparotomy (TL) with implementation of damage control resuscitation (DCR). We hypothesized that implementation of DCR in patients undergoing TL is associated with better outcomes. Methods: We analyzed 1030 consecutive patients with TL. Patients were stratified into 3 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, INR, lactate) parameters were recorded. Regression analysis was performed after adjusting for age, ISS, laboratory and vital parameters, co-morbidities, and resuscitation fluids to identify independent predictors for outcomes in each phase. Results: Patient demographics and ISS remained same through the three phases. There was a significant reduction in 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 pre 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 the transient (OR[95% CI]:1.05[1.01-1.14],p=0.01) phase 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: Implementation of DCR was associated with improved outcome in patients undergoing TL. There was a decrease in the use of damage control laparotomy with decrease in use of crystalloid and increase in use of blood products. Level of Evidence: Level III, Prognostic (C) 2016 Lippincott Williams & Wilkins, Inc.

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