title: Damage control laparotomy: a vital tool once overused.
abstract: 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.
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Arizona 85724, USA.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Higa
authors.forename: Randall
authors.initials: R
authors.lastname: Friese
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Julie
authors.initials: J
authors.lastname: Wynne
authors.forename: Paul
authors.initials: P
authors.lastname: Bowlby
authors.forename: Michelle
authors.initials: M
authors.lastname: Ziemba
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: 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*