title: Short-Term Outcomes and Complications of Damage Control and Definitive Laparotomy in Deployed Combat Environments: 2002 to 2011.
abstract: BACKGROUND
  Damage control laparotomy (DCL) in an austere environment is an evolving surgical modality.
  
  
  METHODS
  A retrospective evaluation of all patients surviving 24 hours who underwent a laparotomy from 2002 to 2011 in Iraq and Afghanistan was performed. DCL was defined as a patient undergoing laparotomy at two distinct North American Treaty Organization (NATO) Role 2 or 3 medical treatment facilities (MTFs); a NATO Roles 2 and 3 MTFs, and/or having the International Classification of Diseases, 9th Revision, Clinical Modification procedure code 54.12, for reopening of recent laparotomy site. Definitive laparotomy (DL) was defined as patients undergoing one operative procedure at one NATO Role 2 or 3 MTF. Demographic data including injury severity scores, hematological transfusion, mortality, intraperitoneal or retroperitoneal operative interventions, and complications were compared.
  
  
  RESULTS
  DCL composed of 26.5% (n = 331) of all 1,248 laparotomies performed between March 2002 and September 2011. Total intra-abdominal, acute respiratory distress syndrome, and thromboembolic complications for DCL versus DL were 8.5% and 5.6% (p = 0.07), 2.1% and 0.8% (p = 0.06), and 1.5% and 0.7% (p = 0.17), respectively. Theater discharge mortality from DCL and DL were 1.5% (n = 5), and 1.4% (n = 13) (p = 0.90), respectively.
  
  
  CONCLUSIONS
  In conclusion, excluding deaths with the first 24 hours, DCL and DL had comparable mortality and complication rates at NATO Roles 2 and 3 MTFs.
authors.affiliation: Department of General Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Mitchell
authors.affiliation: Department of General Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Lauer
authors.affiliation: United States Army Institute of Surgical Research, 3698 Chambers Pass STE B, JBSA Fort Sam Houston, TX 78234-7767.
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.affiliation: Department of General Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.
authors.forename: Kurt D
authors.initials: KD
authors.lastname: Edwards
authors.affiliation: United States Army Institute of Surgical Research, 3698 Chambers Pass STE B, JBSA Fort Sam Houston, TX 78234-7767.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bailey
authors.affiliation: Department of General Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: White
authors.affiliation: Department of General Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Texas Health Sciences Center at Houston, 7000 Fannin Street, Houston, TX 77030.
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000401:mortality / Q000601:surgery*; D006772:Hospitals, Military; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D007813:Laparotomy / Q000379:methods* / Q000401:mortality; D008297:Male; D008887:Military Medicine; D008889:Military Personnel; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D000067398:War-Related Injuries / Q000401:mortality / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*; D055815:Young Adult