title: Surgical complications and causes of death in trauma patients that require temporary abdominal closure.
abstract: Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity and mortality associated with its use in trauma victims. The main goal of this study is to describe the incidence of surgical complications following the use of TAC as well as to define the mortality associated with this procedure. A retrospective review of patients admitted to a state-designated level 1 trauma center from April 2000 to February 2003 was performed. Inclusion criteria were age >18 years, traumatic injury, and need for exploratory laparotomy and use of TAC. A total of 120 patients were included in the study. The overall mortality of trauma patients requiring TAC was 59.2 per cent. The most common causes of death were acute inflammatory process (50.7%), followed by hypovolemic shock (43.7%). The incidence of surgical complications was 26.6 per cent. Intra-abdominal abscesses were the most frequent surgical complication (10%). After multiple logistic regression analysis, increasing age and a numerically greater initial base deficit were found to be independent predictors of mortality in trauma patients that require TAC.
authors.affiliation: University of Puerto Rico School of Medicine, Department of Surgery, Puerto Rico Trauma Center, San Juan, Puerto Rico.
authors.forename: José A
authors.initials: JA
authors.lastname: Montalvo
authors.forename: José A
authors.initials: JA
authors.lastname: Acosta
authors.forename: Pablo
authors.initials: P
authors.lastname: Rodríguez
authors.forename: Kathia
authors.initials: K
authors.lastname: Alejandro
authors.forename: Andrés
authors.initials: A
authors.lastname: Sárraga
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D002423:Cause of Death; D003161:Compartment Syndromes / Q000517:prevention & control; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality*; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014193:Trauma Centers