Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 11/2019

01-11-2019 | Laparotomy | Original Scientific Report

Quality Improvement of Damage Control Laparotomy: Impact of the Establishment of a Single Korean Regional Trauma Center

Authors: Wu Seong Kang, Young Goun Jo, Yun Chul Park

Published in: World Journal of Surgery | Issue 11/2019

Login to get access

Abstract

Background

Damage control laparotomy (DCL) is a lifesaving technique to minimize the lethal triad of coagulopathy, hypothermia, and acidosis. The government has nominated and supported our center as one of the regional trauma centers of South Korea since 2014. This study aimed to investigate the improving outcomes of patients undergoing DCL before and after the establishment of the trauma center.

Method

The period from January 2011 to December 2017 was divided into pre-trauma center (pre-TC) (2011–2013) and trauma center (TC) (2014–2017) periods. Multivariable logistic regression was performed to identify the risk factors and risk-adjusted cumulative sum (RA-CUSUM), and graphs were used to monitor the change in mortality.

Result

Of the 485 patients who underwent trauma laparotomy, DCL was performed for 119 patients (24.5%). The operation time (99 vs. 80 min, p = 0.022), time from admission to operation (125 vs. 112 min, p = 0.010), time from admission to first treatment (119 vs. 99 min, p = 0.004), and time from admission to first transfusion (70 vs. 52 min, p = 0.009) were significantly shortened in the TC period. The ratio of plasma to packed red blood cells in massive transfusions (≥PRBCs 10 units within the first 24 h) was significantly increased in the TC period (0.56 vs. 0.72, p = 0.004). RA-CUSUM curves revealed that the risk-adjusted 30-day mortality improved and then plateaued in the TC period.

Conclusion

After the implementation of a trauma center, more prompt intervention and damage control resuscitation could be achieved. Moreover, risk-adjusted mortality of DCL was improved.
Literature
1.
Shapiro MB, Jenkins DH, Schwab CW, Rotondo MF (2000) Damage control: collective review. J Trauma Acute Care Surg 49(5):969–978CrossRef
2.
Joseph B, Azim A, Zangbar B, Bauman Z, O’Keeffe T, Ibraheem K et al (2017) Improving mortality in trauma laparotomy through the evolution of damage control resuscitation: analysis of 1,030 consecutive trauma laparotomies. J Trauma Acute Care Surg 82(2):328–333CrossRefPubMed
3.
Duke MD, Guidry C, Guice J, Stuke L, Marr AB, Hunt JP et al (2012) Restrictive fluid resuscitation in combination with damage control resuscitation: time for adaptation. J Trauma Acute Care Surg 73(3):674–678CrossRefPubMed
4.
Hatch QM, Osterhout LM, Ashraf A, Podbielski J, Kozar RA, Wade CE et al (2011) Current use of damage-control laparotomy, closure rates, and predictors of early fascial closure at the first take-back. J Trauma 70(6):1429–1436CrossRefPubMed
5.
Cirocchi R, Montedori A, Farinella E, Bonacini I, Tagliabue L, Abraha I (2013) Damage control surgery for abdominal trauma. Cochrane Database Syst Rev 3:Cd007438
6.
Higa G, Friese R, O’Keeffe T, Wynne J, Bowlby P, Ziemba M et al (2010) Damage control laparotomy: a vital tool once overused. J Trauma 69(1):53–59CrossRefPubMed
7.
Cannon JW, Khan MA, Raja AS, Cohen MJ, Como JJ, Cotton BA et al (2017) Damage control resuscitation in patients with severe traumatic hemorrhage: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 82(3):605–617CrossRefPubMed
8.
Park J-M (2016) Outcomes of the support services for the establishment of regional level 1 trauma centers. J Korean Med Assoc 59(12):923–930CrossRef
9.
Healey C, Osler TM, Rogers FB, Healey MA, Glance LG, Kilgo PD et al (2003) Improving the Glasgow Coma Scale score: motor score alone is a better predictor. J Trauma 54(4):671–678; discussion 8–80CrossRefPubMed
10.
Steiner SH, Cook RJ, Farewell VT, Treasure T (2000) Monitoring surgical performance using risk-adjusted cumulative sum charts. Biostatistics (Oxford, England) 1(4):441–452CrossRef
11.
Kim CH, Kim HJ, Huh JW, Kim YJ, Kim HR (2014) Learning curve of laparoscopic low anterior resection in terms of local recurrence. J Surg Oncol 110(8):989–996CrossRefPubMed
12.
Rotondo MF, Schwab CW, McGonigal MD, Phillips GR 3rd, Fruchterman TM, Kauder DR et al (1993) ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 35(3):375–382; discussion 82–83CrossRefPubMed
13.
Martin MJ, Hatch Q, Cotton B, Holcomb J (2012) The use of temporary abdominal closure in low-risk trauma patients: helpful or harmful? J Trauma Acute Care Surg 72(3):601–606; discussion 6–8CrossRefPubMed
14.
Weber DG, Bendinelli C, Balogh ZJ (2014) Damage control surgery for abdominal emergencies. Br J Surg 101(1):e109–e118CrossRefPubMed
15.
Joseph B, Zangbar B, Pandit V, Vercruysse G, Aziz H, Kulvatunyou N et al (2014) The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome. J Trauma Acute Care Surg 76(2):457–461CrossRefPubMed
16.
Harvin JA, Wray CJ, Steward J, Lawless RA, McNutt MK, Love JD et al (2016) Control the damage: morbidity and mortality after emergent trauma laparotomy. Am J Surg 212(1):34–39CrossRefPubMed
17.
Park JS, Ahn HK, Na J, Lee HH, Yoon YE, Yoon MG et al (2018) Cumulative sum analysis of the learning curve for video-assisted minilaparotomy donor nephrectomy in healthy kidney donors. Medicine 97(17):e0560CrossRefPubMedCentralPubMed
18.
Holcomb JB, del Junco DJ, Fox EE, Wade CE, Cohen MJ, Schreiber MA et al (2013) The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg 148(2):127–136CrossRefPubMedCentralPubMed
19.
Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM et al (2015) Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA 313(5):471–482CrossRefPubMedCentralPubMed
20.
Lewis SR, Pritchard MW, Evans DJ, Butler AR, Alderson P, Smith AF et al (2018) Colloids versus crystalloids for fluid resuscitation in critically ill people. Cochrane Database Syst Rev 8:Cd000567PubMed
21.
MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL et al (2006) A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 354(4):366–378CrossRefPubMed
22.
Nathens AB, Jurkovich GJ, Cummings P, Rivara FP, Maier RV (2000) The effect of organized systems of trauma care on motor vehicle crash mortality. JAMA 283(15):1990–1994CrossRefPubMed
23.
24.
Jang JY, Shim H, Jung PY, Kim S, Bae KS (2016) Preperitoneal pelvic packing in patients with hemodynamic instability due to severe pelvic fracture: early experience in a Korean trauma center. Scand J Trauma Resusc Emerg Med 24:3CrossRefPubMedCentralPubMed
25.
Metadata
Title
Quality Improvement of Damage Control Laparotomy: Impact of the Establishment of a Single Korean Regional Trauma Center
Authors
Wu Seong Kang
Young Goun Jo
Yun Chul Park
Publication date
01-11-2019
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 11/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-019-05083-y

Other articles of this Issue 11/2019

World Journal of Surgery 11/2019 Go to the issue

Original Scientific Report

One-Year Postoperative Mortality in MEN1 Patients Operated on Gastric and Duodenopancreatic Neuroendocrine Tumors: An AFCE and GTE Cohort Study

Original Scientific Report with Video

Recurrent Laryngeal Nerve Morbidity: Lessons from Endoscopic via Bilateral Areola and Open Thyroidectomy Technique

Surgery in Low and Middle Income Countries

Building a Large Robotic Thoracic Surgery Program in an Emerging Country: Experience in Brazil

Original Scientific Report

Provision of Surgical Care for Children Across Somaliland: Challenges and Policy Guidance

Scientific Review

Unfinished Business: A Systematic Review of Stump Appendicitis

Original Scientific Report

Ten-year Audit of Safe Bail-Out Alternatives to the Critical View of Safety in Laparoscopic Cholecystectomy