title: Experience of damage control trauma laparotomy in a limited resource healthcare setting: A retrospective Cohort Study.
abstract: BACKGROUND
  Damage control surgery (DCS) is an established option for managing severely injured trauma patients. However, its role in the management of similar patients in the developing world is debatable. The purpose of this study is to describe characteristics and outcomes of patients undergoing DCS.
  
  
  METHODS
  All trauma patients requiring laparotomies from 1996 to 2011 at a tertiary care hospital in South Asia were reviewed. DCS was defined in a patient who underwent a truncated laparotomy where the fascia was primarily left open, with the intention of physiological optimization in the Intensive Care Unit, followed by definitive surgery. The primary outcome was in-hospital mortality. Multivariate logistic regression was used to determine the independent predictors of mortality after adjustment for potential confounders.
  
  
  RESULTS
  Of 258 patients, 47 underwent DCS. 40% patients were transferred from other hospitals. The time between injury and operation was 152 minutes (IQR: 90-330). Intra-operative laboratory parameters revealed a median pH of 7.16 (IQR: 7.10-7.27), median temperature of 34.7 (IQR: 34.0-35.4) and median PT of 15.9 (IQR: 12.4-21.2). 55% of the patients survived to discharge from hospital. Of those who died, 86% died before the first take back operation. Packed red blood cell transfusion and vascular injury were independently associated with mortality.
  
  
  CONCLUSIONS
  Damage control surgery is feasible in developing countries, with more than 50% survival reported at one hospital. Future research should focus on critical care management.
  
  
  CONCLUSIONS
  Damage Control trauma laparotomy is feasible in tertiary care hospitals with multidisciplinary trauma teams in lesser-developed countries.
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan; Aga Khan University-Johns Hopkins Trauma Outcomes Research Collaboration, Pakistan. Electronic address: mehreenkisat@email.arizona.edu.
authors.forename: Mehreen
authors.initials: M
authors.lastname: Kisat
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan; Aga Khan University-Johns Hopkins Trauma Outcomes Research Collaboration, Pakistan.
authors.forename: Syed Nabeel
authors.initials: SN
authors.lastname: Zafar
authors.affiliation: Center for Surgery Trials and Outcomes Research, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Aga Khan University-Johns Hopkins Trauma Outcomes Research Collaboration, Pakistan.
authors.forename: Zain G
authors.initials: ZG
authors.lastname: Hashmi
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Amyn
authors.initials: A
authors.lastname: Pardhan
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Tahreem
authors.initials: T
authors.lastname: Mir
authors.affiliation: Center for Surgery Trials and Outcomes Research, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Aga Khan University-Johns Hopkins Trauma Outcomes Research Collaboration, Pakistan.
authors.forename: Adil
authors.initials: A
authors.lastname: Shah
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Hasnain
authors.initials: H
authors.lastname: Zafar
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D003906:Developing Countries; D000071938:Fasciotomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007813:Laparotomy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Damage control surgery; Mortality; Trauma