Time is domain: factors affecting primary fascial closure after trauma and non-trauma damage control laparotomy (data from the EAST SLEEP-TIME multicenter registry)

AUTHORS

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 , . European journal of trauma and emergency surgery : official publication of the European Trauma Society. 2021 11 29; ().

PMID: 34845499 [PubMed].

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.

Tags: alumni publications 2021