title: Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy.
abstract: BACKGROUND
  Failure to achieve primary fascial closure (PFC) after damage control laparotomy is costly and carries great morbidity. We hypothesized that time from the initial laparotomy to the first take-back operation would be predictive of successful PFC.
  
  
  METHODS
  Trauma patients managed with open abdominal techniques after damage control laparotomy were prospectively followed at 14 Level 1 trauma centers during a 2-year period. Time to the first take-back was evaluated as a predictor of PFC using hierarchical multivariate logistic regression analysis.
  
  
  RESULTS
  A total of 499 patients underwent damage control laparotomy and were included in this analysis. PFC was achieved in 327 (65.5%) patients. Median time to the first take-back operation was 36 hours (interquartile range 24-48). After we adjusted for patient demographics, resuscitation volumes, and operative characteristics, increasing time to the first take-back was associated with a decreased likelihood of PFC. Specifically, each hour delay in return to the operating room (24 hours after initial laparotomy) was associated with a 1.1% decrease in the odds of PFC (odds ratio 0.989; 95% confidence interval 0.978-0.999; P = .045). In addition, there was a trend towards increased intra-abdominal complications in patients returning after 48 hours (odds ratio 1.80; 95% confidence interval 1.00-3.25; P = .05).
  
  
  CONCLUSIONS
  Data from this prospective, multicenter study demonstrate that delays in returning to the operating room after damage control laparotomy are associated with reductions in PFC. These findings suggest that emphasis should be placed on returning to the operating room within 24 hours after the initial laparotomy if possible (and no later than 48 hours).
authors: Department of Surgery, The University of Texas Health Science Center, Houston, TX; Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX.
authors: Matthew J
authors: MJ
authors: Pommerening
authors: Department of Surgery, The University of Texas Health Science Center, Houston, TX.
authors: Joseph J
authors: JJ
authors: DuBose
authors: Department of Surgery, Mayo Clinic, Rochester, MN.
authors: Martin D
authors: MD
authors: Zielinski
authors: Department of Surgery, University Of Texas Southwestern Medical Center, Dallas, TX.
authors: Herb A
authors: HA
authors: Phelan
authors: The R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
authors: Thomas M
authors: TM
authors: Scalea
authors: Department of Surgery, Los Angeles County + University of Southern California Hospital, Los Angeles, CA.
authors: Kenji
authors: K
authors: Inaba
authors: Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, MA.
authors: George C
authors: GC
authors: Velmahos
authors: Division of Trauma, Critical Care, and Emergency Surgery, Virginia Commonwealth University, Richmond, VA.
authors: James F
authors: JF
authors: Whelan
authors: Department of Surgery, The University of Texas Health Science Center, Houston, TX; Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX.
authors: Charles E
authors: CE
authors: Wade
authors: Department of Surgery, The University of Texas Health Science Center, Houston, TX; Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX.
authors: John B
authors: JB
authors: Holcomb
authors: Department of Surgery, The University of Texas Health Science Center, Houston, TX; Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. Electronic address: bryan.a.cotton@uth.tmc.edu.
authors: Bryan A
authors: BA
authors: Cotton
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012086:Reoperation; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000601:surgery