title: Control the damage: morbidity and mortality after emergent trauma laparotomy.
abstract: BACKGROUND
  Damage control laparotomy (DCL) is performed for physiologically deranged patients. Recent studies suggest overutilization of DCL, which may be associated with potentially iatrogenic complications.
  
  
  METHODS
  We conducted a retrospective study of trauma patients over a 2-year period that underwent an emergent laparotomy and received preoperative blood products. The group was divided into definitive laparotomy and DCL.
  
  
  RESULTS
  A total of 237 received were included: 78 in definitive laparotomy group, 144 in the DCL group, and 15 who died in the operating room. The DCL group was more severely injured and required more transfusions. After propensity score matching, DCL was associated with an 18% increase in hospital mortality, a 13% increase in ileus, and a 7% increase in enteric suture line failure, an 11% increase in fascial dehiscence, and a 19% increase in superficial surgical site infection.
  
  
  CONCLUSIONS
  The potential overuse of DCL unnecessarily exposes patients to increased morbidity and mortality.
authors.affiliation: Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX 77030, USA. Electronic address: john.harvin@uth.tmc.edu.
authors.forename: John A
authors.initials: JA
authors.lastname: Harvin
authors.affiliation: Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX 77030, USA.
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Wray
authors.affiliation: Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX 77030, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Steward
authors.affiliation: Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX 77030, USA.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Lawless
authors.affiliation: Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX 77030, USA.
authors.forename: Michelle K
authors.initials: MK
authors.lastname: McNutt
authors.affiliation: Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX 77030, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Love
authors.affiliation: Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX 77030, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Moore
authors.affiliation: Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX 77030, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.affiliation: Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX 77030, USA.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Cotton
authors.affiliation: Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX 77030, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D002423:Cause of Death; D004638:Emergency Treatment / Q000379:methods / Q000401:mortality; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014193:Trauma Centers
keywords: Complications; Damage control laparotomy; Morbidity; Mortality; Trauma