"Damage control" in the elderly: futile endeavor or fruitful enterprise?
BACKGROUND
Damage control laparotomy (DCL) provides effective management in carefully selected, exsanguinating trauma patients. However, the effectiveness of this approach has not been examined in the elderly. The purpose of this study was to characterize elderly DCL patients.


METHODS
The National Trauma Registry of the American College of Surgeons was queried for patients admitted to our Level I trauma center between January 2003 and June 2008. Patients who underwent a DCL were included in the study. Elderly (55 years or older) and young (16-54 years) patients were compared for demographics, injury severity, intraoperative transfusion volume, complications, and mortality.


RESULTS
During the study period, 62 patients met inclusion criteria. Elderly and young cohorts were similar in gender (male, 78.6% vs. 75.0%, p = 0.78), Injury Severity Score (25.1 ± 2.1 vs. 23.8 ± 1.7, p = 0.49), packed red blood cell transfusion volume (3036 mL ± 2760 mL vs. 2654 mL ± 2194 mL, p = 0.51), and number of complications (3.21 ± 0.48 vs. 3.33 ± 0.38, p = 0.96). Mortality was greater in the elderly cohort (42.9% vs. 12.5%, p = 0.02). The mean time to death for the elderly was 9.8 days ± 10.2 days and 26 days ± 21.5 days in the young (p = 0.485).


CONCLUSIONS
Despite the severity of injury, the outcome of elderly DCL patients is better than what might be predicted. They succumb to their injuries more frequently and earlier in the hospital course compared with the young, but the majority of these patients survive. DCL in the elderly is not a futile endeavor.
Department of Surgery, The Brody School of Medicine at East Carolina University, The Center of Excellence for Trauma and Surgical Critical Care, University Health Systems of Eastern Carolina, Greenville, North Carolina 27834-4354, USA. mnewell@pcmh.com
Mark A
MA
Newell
Lisa L
LL
Schlitzkus
Brett H
BH
Waibel
Michael A
MA
White
Paul J
PJ
Schenarts
Michael F
MF
Rotondo
D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D018447:Medical Futility; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D055815:Young Adult