title: Use of damage control and the open abdomen in combat.
abstract: Despite the well-documented use of damage control laparotomy (DCL) in civilian trauma, its use has not been well described in the combat setting. Therefore, we sought to document the use of DCL and to investigate its effect on patient outcome. Prospective data were collected on 1603 combat casualties injured between April 2003 and January 2009. One hundred seventy patients (11%) underwent an exploratory laparotomy (ex lap) in theater and comprised the study cohort. DCL was defined as an abbreviated ex lap resulting in an open abdomen. Patients were stratified by age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), mechanism of injury, and blood product administration. Multivariate regression analyses were used to determine risks factors for intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), and the need for DCL. Mean age of the cohort was 24 ± 5 years, ISS was 21 ± 11, and 94 per cent sustained penetrating injury. Patients with DCL comprised 50.6 per cent (n = 86) of the study cohort and had significant increases in ICU admission (P < 0.001), ICU LOS (P < 0.001), HLOS (P < 0.05), ventilator days (P < 0.001), abdominal complications (P < 0.05), but not mortality (P = 0.65) compared with patients without DCL. When compared with the non-DCL group, patients undergoing DCL required significantly more blood products (packed red blood cells, fresh-frozen plasma, platelets, and cryoprecipitate; P < 0.001). Multivariate regression analyses revealed blood transfusion and GCS as significant risk factors for DCL (P < 0.05). Patients undergoing DCL had increased complications and resource use but not mortality compared with patients not undergoing DCL. The need for combat DCL may be different compared with civilian use. Prospective studies to evaluate outcomes of DCL are warranted.
authors.affiliation: Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA. Benjamin.A.Bograd.mil@health.mil
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bograd
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodriguez
authors.forename: Richard
authors.initials: R
authors.lastname: Amdur
authors.forename: Fred
authors.initials: F
authors.lastname: Gage
authors.forename: Eric
authors.initials: E
authors.lastname: Elster
authors.forename: James
authors.initials: J
authors.lastname: Dunne
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003422:Critical Care / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D054542:Iraq War, 2003-2011; D007813:Laparotomy; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States; D014947:Wounds and Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*