title: Long-term impact of damage control laparotomy: a prospective study.
abstract: OBJECTIVE
  Damage control laparotomy (DCL) has beneficial effects on the long-term morbidity and survival of trauma patients.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Eighty-eight trauma patients who were admitted during a 3-year period (January 1, 2000, through December 31, 2003) underwent damage control laparotomy and were subsequently followed up (January 1, 2001, through December 31, 2008).
  
  
  METHODS
  Damage control laparotomy.
  
  
  METHODS
  Major and long-term complications, lengths of stay, mortality, readmissions, subsequent surgical procedures, activities of daily living, and return to work.
  
  
  RESULTS
  On admission, the mean age and Injury Severity Score were 33 years and 34, respectively. Of the 88 patients, 66 (75%) were male; 46 patients had blunt injuries and 42 had penetrating injuries. Liver was the most common injury (63 patients), followed by bowel (34), spleen (33), major vessel (19), and pancreas (10). The mean admission pH and temperature were 7.19 and 34.4°C, respectively, with 21.5 U of packed red blood cells transfused. The mean (SD) number of initial abdominal operations was 4.6 (2.5) per patient, with an overall mortality of 28% (25 patients). Intensive care unit and hospital lengths of stay were 18 (15) and 32 (20) days, respectively. Of the 63 patients who survived, 58 underwent intra-abdominal closure with polyglactin mesh. During the study, 44 intra-abdominal infections and 18 enterocutaneous fistulas were diagnosed. All 63 survivors were readmitted at least once. There were a total of 186 readmissions and 92 subsequent surgical procedures. Ventral hernia repair (66 readmissions) was the most common reason for readmission, followed by infection (41) and fistula management (29). There was 0% mortality for patients who survived the preliminary hospitalization. Of the 63 surviving patients, 51 (81%) reported that they had gone back to work and resumed normal daily activities.
  
  
  CONCLUSIONS
  Although damage control laparotomy is associated with a significant complication and readmission rate, its overall benefit is indisputable.
authors.affiliation: R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD 21201, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Brenner
authors.forename: Grant
authors.initials: G
authors.lastname: Bochicchio
authors.forename: Kelly
authors.initials: K
authors.lastname: Bochicchio
authors.forename: Obeid
authors.initials: O
authors.lastname: Ilahi
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rodriguez
authors.forename: Sharon
authors.initials: S
authors.lastname: Henry
authors.forename: Manjari
authors.initials: M
authors.lastname: Joshi
authors.forename: Thomas
authors.initials: T
authors.lastname: Scalea
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality / Q000601:surgery; D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D015142:Baltimore; D001803:Blood Transfusion; D005260:Female; D005402:Fistula / Q000209:etiology / Q000628:therapy; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery; D006801:Humans; D007239:Infections / Q000209:etiology / Q000628:therapy; D015601:Injury Severity Score; D007813:Laparotomy / Q000009:adverse effects; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D014193:Trauma Centers; D057772:Vascular System Injuries / Q000401:mortality / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000401:mortality* / Q000601:surgery*; D014950:Wounds, Penetrating / Q000401:mortality* / Q000601:surgery*