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Kwon E, Krause C, Luo-Owen X, McArthur K, Cochran-Yu M, Swentek L, Burruss S, Turay D, Krasnoff C, Grigorian A, Nahmias J, Butt A, Gutierrez A, LaRiccia A, Kincaid M, Fiorentino M, Glass N, Toscano S, Ley EJ, Lombardo S, Guillamondegui O, Bardes JM, DeLa'O C, Wydo S, Leneweaver K, Duletzke N, Nunez J, Moradian S, Posluszny J, Naar L, Kaafarani H, Kemmer H, Lieser M, Hanson I, Chang G, Bilaniuk JW, Nemeth Z, Mukherjee K. Time is domain: factors affecting primary fascial closure after trauma and non-trauma damage control laparotomy (data from the EAST SLEEP-TIME multicenter registry). Eur J Trauma Emerg Surg 2021; 48:2107-2116. [PMID: 34845499 DOI: 10.1007/s00068-021-01814-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Damage control laparotomy (DCL) is used for both traumatic and non-traumatic indications. Failure to achieve primary fascial closure (PFC) in a timely fashion has been associated with complications including sepsis, fistula, and mortality. We sought to identify factors associated with time to PFC in a multicenter retrospective cohort. METHODS We reviewed retrospective data from 15 centers in the EAST SLEEP-TIME registry, including age, comorbidities (Charlson Comorbidity Index [CCI]), small and large bowel resection, bowel discontinuity, vascular procedures, retained packs, number of re-laparotomies, net fluid balance after 24 h, trauma, and time to first takeback in 12-h increments to identify key factors associated with time to PFC. RESULTS In total, 368 patients (71.2% trauma, of which 50.6% were penetrating, median ISS 25 [16, 34], with median Apache II score 15 [11, 22] in non-trauma) were in the cohort. Of these, 92.9% of patients achieved PFC at 60.8 ± 72.0 h after 1.6 ± 1.2 re-laparotomies. Each additional re-laparotomy reduced the odds of PFC by 91.5% (95%CI 88.2-93.9%, p < 0.001). Time to first re-laparotomy was highly significant (p < 0.001) in terms of odds of achieving PFC, with no difference between 12 and 24 h to first re-laparotomy (ref), and decreases in odds of PFC of 78.4% (65.8-86.4%, p < 0.001) for first re-laparotomy after 24.1-36 h, 90.8% (84.7-94.4%, p < 0.001) for 36.1-48 h, and 98.1% (96.4-99.0%, p < 0.001) for > 48 h. Trauma patients had increased likelihood of PFC in two separate analyses (p = 0.022 and 0.002). CONCLUSION Time to re-laparotomy ≤ 24 h and minimizing number of re-laparotomies are highly predictive of rapid achievement of PFC in patients after trauma- and non-trauma DCL. LEVEL OF EVIDENCE 2B.
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Affiliation(s)
- Eugenia Kwon
- Division of Acute Care Surgery, Loma Linda University Medical Center, 11175 Campus Street CP 21111, Loma Linda, CA, 92350, USA
| | - Cassandra Krause
- Division of Acute Care Surgery, Loma Linda University Medical Center, 11175 Campus Street CP 21111, Loma Linda, CA, 92350, USA
| | - Xian Luo-Owen
- Division of Acute Care Surgery, Loma Linda University Medical Center, 11175 Campus Street CP 21111, Loma Linda, CA, 92350, USA
| | | | - Meghan Cochran-Yu
- Division of Acute Care Surgery, Loma Linda University Medical Center, 11175 Campus Street CP 21111, Loma Linda, CA, 92350, USA
| | - Lourdes Swentek
- Trauma, Critical Care, Acute Care and Burn Surgery, UC Irvine Medical Center, Orange, CA, USA
| | - Sigrid Burruss
- Division of Acute Care Surgery, Loma Linda University Medical Center, 11175 Campus Street CP 21111, Loma Linda, CA, 92350, USA
| | - David Turay
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Chloe Krasnoff
- Trauma, Critical Care, Acute Care and Burn Surgery, UC Irvine Medical Center, Orange, CA, USA
| | - Areg Grigorian
- Trauma, Critical Care, Acute Care and Burn Surgery, UC Irvine Medical Center, Orange, CA, USA
| | - Jeffrey Nahmias
- Trauma, Critical Care, Acute Care and Burn Surgery, UC Irvine Medical Center, Orange, CA, USA
| | - Ahsan Butt
- USC-Keck School of Medicine, Los Angeles, CA, USA
| | - Adam Gutierrez
- General Surgery, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Aimee LaRiccia
- General Surgery, Ohio Health Grant Medical Center, Columbus, OH, USA
| | - Michelle Kincaid
- General Surgery, Ohio Health Grant Medical Center, Columbus, OH, USA
| | - Michele Fiorentino
- Trauma and Surgical Critical Care, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Nina Glass
- Trauma and Surgical Critical Care, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Samantha Toscano
- General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eric Jude Ley
- General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sarah Lombardo
- Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Oscar Guillamondegui
- Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James Migliaccio Bardes
- Trauma, Acute Care Surgery and Surgical Critical Care, West Virginia University, Morgantown, WV, USA
| | - Connie DeLa'O
- Trauma, Acute Care Surgery and Surgical Critical Care, West Virginia University, Morgantown, WV, USA
| | - Salina Wydo
- Trauma, Cooper University Health System, Camden, NJ, USA
| | | | - Nicholas Duletzke
- General Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Jade Nunez
- General Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Simon Moradian
- Trauma and Critical Care, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Joseph Posluszny
- Trauma and Critical Care, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Leon Naar
- Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Haytham Kaafarani
- Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Heidi Kemmer
- Surgery, Research Medical Center-Kansas City Hospital, Kansas City, MO, USA
| | - Mark Lieser
- Surgery, Research Medical Center-Kansas City Hospital, Kansas City, MO, USA
| | - Isaac Hanson
- Trauma and Critical Care Surgery, Mount Sinai Hospital-Chicago, Chicago, IL, USA
| | - Grace Chang
- Trauma and Critical Care Surgery, Mount Sinai Hospital-Chicago, Chicago, IL, USA
| | | | - Zoltan Nemeth
- Surgery, Morristown Medical Center, Morristown, NJ, USA
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, 11175 Campus Street CP 21111, Loma Linda, CA, 92350, USA.
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