Comparison of abdominal damage control surgery in combat versus civilian trauma.
BACKGROUND
The majority of individuals who perform damage control surgery in the military arena are trained in civilian venues. Therefore, it is important to compare and contrast damage control performed in civilian and military settings. In contrast to civilian trauma, which is primarily caused by blunt injury and addressed at one or two surgical facilities, combat casualties primarily sustain explosion-related injuries and undergo treatment at multiple levels of care across continents. We aimed to compare patients undergoing abdominal damage control surgery across these two very different settings.


METHODS
Parallel retrospective reviews were conducted over 2 years (2005-2006) in a combat setting and at a US Level I trauma center. Patients were examined during the first 7 days after injury.


RESULTS
The civilian population (CP) was older (40 vs. 23; p < 0.01) with a higher injury severity score (35 vs. 27; p < 0.02). The CP experienced greater blunt injury than the military population (MP) (83 vs. 4%; p < 0.01). Explosion-related injury was only present in the MP (64%). At baseline, the CP presented with lower systolic blood pressure (108 vs. 126) and larger base deficit (9.8 vs. 6.5; p < 0.05). The MP underwent more surgeries (3.5 vs. 2.9; p = 0.02) with similar rates of fascial closure (48.7% vs. 70.0%; p = 0.11). Complication rates were similar between the CP and the MP (43% vs. 58%, respectively; p = 0.14).


CONCLUSIONS
Military and civilian trauma patients who undergo damage control surgery experience similar fascial closure rates despite differing demographics and widely disparate mechanisms of injury. The MP undergoes a greater number of procedures than the CP, but complication rates do not differ between the groups.
Sambasivan
Chitra N
CN
Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.
Underwood
Samantha J
SJ
Cho
S D
SD
Kiraly
Laszlo N
LN
Hamilton
Greg J
GJ
Kofoed
J T
JT
Flaherty
Stephen F
SF
Dorlac
Warren C
WC
Schreiber
Martin A
MA
D000007:Abdominal Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006772:Hospitals, Military; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D016343:Monitoring, Intraoperative / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014857:Warfare; D055815:Young Adult