title: Outcomes of damage-control celiotomy in elderly nontrauma patients with intra-abdominal catastrophes.
abstract: OBJECTIVE
  Damage-control laparotomy, initially developed for trauma patients, has expanded into the general surgery arena. Little evidence exists regarding the utility of damage-control celiotomy (DCCT) in elderly nontrauma patients. Our objective was to review the management and outcomes of DCCT in elderly patients with intra-abdominal catastrophes.
  
  
  METHODS
  Retrospective chart review from 1998 to 2008 identified cases of DCCT. Demographics, comorbidities, surgical techniques, morbidity, long-term disposition, and mortality were analyzed.
  
  
  RESULTS
  From 210 patients with emergency surgeries, 88 (42%) patients with DCCT were identified, 33 (38%) were greater than 65 years old and 55 (63%) were ≤ 65 years old. The average APACHE IV score for the elderly was 84 ± 2 versus 68 ± 2 for the younger group (p < .001). Elderly patients had significantly higher comorbidites with respect to cardiovascular, pulmonary, and renal disease. When comparing the 2 groups, there were no significant differences in-hospital or intensive care unit lengths of stay or ventilator days. There were also no significant differences in complications and disposition. Using Cox proportional hazards analysis, age was not an independent predictor of 30-day mortality.
  
  
  CONCLUSIONS
  Age is not an independent predictor of worse outcomes in patients managed by the DCCT technique after intra-abdominal catastrophes. This management technique should be considered for elderly patients who require DCCT.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Veterans Affairs Hospital, Houston, TX 77030, USA. asubrama@bcm.edu
authors.forename: Anuradha
authors.initials: A
authors.lastname: Subramanian
authors.forename: Courtney
authors.initials: C
authors.lastname: Balentine
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Palacio
authors.forename: Shubhada
authors.initials: S
authors.lastname: Sansgiry
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
authors.forename: Samir S
authors.initials: SS
authors.lastname: Awad
mesh_terms: D018806:APACHE; D000006:Abdomen, Acute / Q000175:diagnosis / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D003422:Critical Care; D004630:Emergencies; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D016896:Treatment Outcome