Postoperative neuromuscular blocker use is associated with higher primary fascial closure rates after damage control laparotomy.
BACKGROUND
Failure to achieve fascial primary closure after damage control laparotomy (DCL) is associated with increased morbidity, higher healthcare expenditures, and a reduction in quality of life. The use of neuromuscular blocking agents (NMBA) to facilitate closure remains controversial and poorly studied. The purpose of this study was to determine whether exposure to NMBA is associated a higher likelihood of primary fascial closure.


METHODS
All adult trauma patients admitted between January 2002 and May 2008 who (1) went directly to the operating room, (2) were managed initially by DCL, and (3) survived to undergo a second laparotomy. Study group (NMBA+): those receiving NMBA in the first 24 hours after DCL. Comparison group (NMBA-): those not receiving NMBA in the first 24 hours after DCL. Primary fascial closure defined as fascia-to-fascia approximation by hospital day 7.


RESULTS
One hundred ninety-one patients met inclusion (92 in NMBA+ group, 99 in NMBA- group). Although the NMB+ patients were younger (31 years vs. 37 years, p = 0.009), there were no other differences in demographics, severity of injury, or lengths of stay between the groups. However, NMBA+ patients achieved primary closure faster (5.1 days vs. 3.5 days, p = 0.046) and were more likely to achieve closure by day 7 (93% vs. 83%, p = 0.023). After controlling for age, gender, race, mechanism, and severity of injury, logistic regression identified NMBA use as an independent predictor of achieving primary fascial closure by day 7 (OR, 3.24, CI: 1.15-9.16; p = 0.026).


CONCLUSIONS
Early NMBA use is associated with faster and more frequent achievement of primary fascial closure in patients initially managed with DCL. Patients exposed to NMBA had a three times higher likelihood of achieving primary fascial closure by hospital day 7.
Abouassaly
Chadi T
CT
Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Dutton
William D
WD
Zaydfudim
Victor
V
Dossett
Lesly A
LA
Nunez
Timothy C
TC
Fleming
Sloan B
SB
Cotton
Bryan A
BA
D000328:Adult; D005205:Fascia / Q000293:injuries*; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D016017:Odds Ratio; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000517:prevention & control; D013997:Time Factors; D014945:Wound Healing / Q000187:drug effects*; D014950:Wounds, Penetrating / Q000188:drug therapy / Q000601:surgery*; D055815:Young Adult
D009466:Neuromuscular Blocking Agents