Akella Chendrasekhar
Use of Damage control surgery (DCS) continues to be
a topic of debate in Trauma(T) and Acute Care Surgery(
ACS) patients. DCS has been accepted as beneficial
despite the paucity of evidence. DCS was designed
to help patients overcome the “Lethal Triad” of acidosis,
coagulopathy and hypothermia.
We performed a retrospective analysis on 51 patients undergoing
DCS for Trauma (n=26) or ACS (n=25). We
collected demographic and outcome data including age,
gender, ICU (ICU-LOS), hospital length of stay (H-LOS),
ventilator days, open abdomen days, returns to OR, and
survival to discharge. The median age for Trauma was
48 vs 50 for ACS (p=n.s). H-LOS, ICU-LOS, ventilator
days were all longer in Trauma vs ACS. At least 1 component
of the triad was present in 85% of Trauma patients
vs 36% for ACS (p<0.05). ISS in trauma correlated with
survival. There was no correlation between the presence
of triad and survival in trauma patients. The presence
of triad reduced survival in ACS from 100% to 77.7 %
(p<0.05). Average duration of open abdomen was longer
in trauma (6.5 + 0.4 days) vs ACS (3.6 + 0.4 days, p<0.05)
as was the number of returns to the OR. Overall survival
comparing DCS Trauma (77%) vs DCS for ACS (92%)
was not statistically significant.
Conclusion: We found that DCS is used more often in
ACS patients without presence of the lethal triad suggesting
overuse in this patient population. Trauma mortality
does not seem to correlate with the number of components
of the lethal triad present