title: The use of temporary abdominal closure in low-risk trauma patients: helpful or harmful?
abstract: BACKGROUND
  Temporary abdominal closure (TAC) has become a widely used technique in severely injured patients. However, there is growing concern that TAC is being overutilized. We sought to identify less severely injured patients who underwent TAC and to compare their outcomes with patients managed with a single-stage laparotomy (SSL).
  
  
  METHODS
  This is a analysis of all trauma patients who underwent immediate laparotomy from 2005 to 2009. Risk modeling identified TAC patients who met all low-risk criteria: systolic blood pressure >90, no severe head injury, no combined solid + hollow viscus injury, or vascular injury. The low-risk cohort (LR-TAC) was compared with a matched similarly injured cohort managed with SSL using univariate and multivariate regression analysis.
  
  
  RESULTS
  Among the 282 patients undergoing TAC, 62 (22%) met low-risk criteria and were included in the LR-TAC group. There were 566 patients identified in the SSL group. There was no significant difference between groups for age, mechanism, Injury Severity Scores, associated injuries, base deficit, temperature, blood transfusion, solid organ injury, or bowel resection. The LR-TAC group had more hospital and ventilator days and increased complications rates (all p < 0.05). This included a higher rate of bowel ischemia/perforation with LR-TAC (7% vs. 0.7%). The use of TAC in the low-risk group was independently associated with increased complications (odds ratio 3.0, p = 0.01) and prolonged hospital stays (odds ratio 9.6, p < 0.01).
  
  
  CONCLUSIONS
  TAC was associated with increased morbidity and resource utilization when applied to less severely injured patients. Further study is indicated to clarify populations that may be harmed or benefitted by TAC.
  
  
  METHODS
  : III, therapeutic study.
authors.affiliation: Division of Trauma, Legacy Emanuel Medical Center, Portland, Oregon, USA. matthew.martin1@amedd.army.mil
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Martin
authors.forename: Quinton
authors.initials: Q
authors.lastname: Hatch
authors.forename: Bryan
authors.initials: B
authors.lastname: Cotton
authors.forename: John
authors.initials: J
authors.lastname: Holcomb
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007813:Laparotomy / Q000379:methods / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013536:Suture Techniques / Q000706:statistics & numerical data*; D013781:Texas / Q000453:epidemiology; D014193:Trauma Centers; D016896:Treatment Outcome; D014218:Triage