Incidence of and factors associated with damage control laparotomy in adult patients undergoing emergency laparotomy following abdominal trauma: A retrospective cohort study from a UK Major trauma centre

Background: Damage control laparotomy may be used to manage abdominal trauma. UK damage control laparotomy guidelines are limited and non-specific, suggesting its use may be attributed to a surgeon's experience rather than consistent parameters. This study aimed to determine the incidence of, and factors associated with, damage control laparotomy in adult patients undergoing emergency laparotomy following abdominal trauma, at a major trauma centre (MTC) in the UK.

Methods: A single-centre retrospective cohort study was undertaken, in which the UK Trauma Audit and Research Network (TARN) database was used to select eligible patients who suffered abdominal trauma and underwent an emergency laparotomy within 12 h of arrival to a MTC in the UK, between 01/01/2021 and 31/01/2023. The factors associated with management by damage control laparotomy compared to definitive laparotomy were reported and logistic regression analysis used to investigate associations between age, Glasgow Coma Scale (GCS), injury severity score (ISS), and shock index, metabolic acidosis and requirement for blood products with the outcomes of management by damage control laparotomy and subsequent mortality.

Results: Of the 63 patients eligible for this study, 21% (n = 13) underwent damage control laparotomy with a median age of 25, and 92% (n = 58) were male. The most common mechanism of injury in patients that underwent DCL were road traffic collisions (46%) and stabbings (46%) with mortality at 30 days of 23% (n = 3). Lower GCS and higher ISS were significantly associated with mortality.

Conclusions: A fifth of trauma patients with abdominal injuries had damage control surgery, and this associated with lower GCS. Lower GCS and higher ISS were associated with mortality, this may be due to the presence of systemic shock and critical illness, which are likely contribute to a higher physiological burden and poorer outcome.