Damage control laparotomy: a vital tool once overused.
BACKGROUND
Trauma surgery is in constant evolution as is the use of damage control laparotomy (DCL). The purpose of this study was to report the change in usage of DCL over time and its effect on outcome.


METHODS
Trauma patients requiring laparotomies during a 3-year (2006-2008) period were reviewed. DCL was defined as laparotomy when fascia was not closed at the first operation.


RESULTS
There were 14,534 trauma patients evaluated, and 843 laparotomies were performed on 532 patients during the study period. The number of patients requiring open laparotomies slightly increased while the demographics and Injury Severity Score were similar during the study period. The number of patient requiring DCL significantly decreased from 36.3% (53 of 146) in 2006 to 8.8% (15 of 170) in 2008 (p < 0.001). During this same time period, the mortality rate for patients requiring open laparotomy significantly decreased from 21.9% in 2006 to 12.9% in 2008 (p = 0.05). The decreased use of DCL resulted in a 33.3% reduction in the number of laparotomies performed. The decrease in average costs and charges is projected to result in savings of $2.2 million and $5.8 million, respectively.


CONCLUSIONS
The use of DCL was significantly decreased by 78% during the study with significantly improved outcome. The improved outcome and decreased resource utilization can reduce health care costs and charges. Although DCL may be a vital aspect of trauma surgery, it can be used more selectively with improved outcome.
Higa
Guillermo
G
Department of Surgery, University of Arizona, Tucson, Arizona 85724, USA.
Friese
Randall
R
O'Keeffe
Terence
T
Wynne
Julie
J
Bowlby
Paul
P
Ziemba
Michelle
M
Latifi
Rifat
R
Kulvatunyou
Narong
N
Rhee
Peter
P
D000328:Adult; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006470:Hemorrhage / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000191:economics / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000191:economics / Q000601:surgery*