Control the damage: morbidity and mortality after emergent trauma laparotomy

• In bleeding patients, damage control laparotomy (DCL) can be life-saving.
• In this cohort of bleeding patients, DCL appears overused.
• DCL is associated with an increase in multiple complications.
• DCL is associated with an 18% increase in mortality.
• Overutilization of DCL exposes patients to potentially iatrogenic complications.

BackgroundDamage control laparotomy (DCL) is performed for physiologically deranged patients. Recent studies suggest overutilization of DCL, which may be associated with potentially iatrogenic complications.MethodsWe 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.ResultsA 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.ConclusionsThe potential overuse of DCL unnecessarily exposes patients to increased morbidity and mortality.