Damage Control Laparotomy: High-Volume Centers Display Similar Mortality Rates Despite Differences in Country Income Lev
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SURGERY IN LOW AND MIDDLE INCOME COUNTRIES
Damage Control Laparotomy: High-Volume Centers Display Similar Mortality Rates Despite Differences in Country Income Level Michael D. Traynor Jr1 • Matthew C. Hernandez1 • Johnathon M. Aho1 • Kevin Wise1 Victor Kong2,3 • Damian Clarke2,3 • John A. Harvin4 • Martin D. Zielinski1
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Accepted: 17 July 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Comprehensive analysis of trauma care between high-, middle-, and low-income countries (HIC/MIC/ LIC) is needed to improve global health. Comparison of HIC and MIC outcomes after damage control laparotomy (DCL) for patients is unknown. We evaluated DCL utilization among patients treated at high-volume trauma centers in the USA and South Africa, an MIC, hypothesizing similar mortality outcomes despite differences in resources and setting. Methods Post hoc analysis of prospectively collected trauma databases from participating centers was performed. Injury severity, physiologic, operative data and post-operative outcomes were abstracted. Univariate and multivariable analyses were performed to assess differences between HIC/MIC for the primary outcome of mortality. Results There were 967 HIC and 602 MIC patients who underwent laparotomy. DCL occurred in 144 MIC patients (25%) and 241 HIC (24%) patients. Most sustained (58%) penetrating trauma with higher rates in the MIC compared to the HIC (71 vs. 32%, p = 0.001). Between groups, no differences were found for admission physiology, coagulopathy, or markers of shock except for increased presence of hypotension among patients in the HIC. Crystalloid infusion volumes were greater among MIC patients, and MIC patients received fewer blood products than those in the HIC. Overall mortality was 30% with similar rates between groups (29 in HIC vs. 33% in MIC, p = 0.4). On regression, base excess and penetrating injury were independent predictors of mortality but not patient residential status. Conclusion Use and survival of DCL for patients with severe abdominal trauma was similar between trauma centers in HIC and MIC settings despite increased penetrating trauma and less transfusion in the MIC center. While the results overall suggest no gap in care for patients requiring DCL in this MIC, it highlights improvements that can be made in damage control resuscitation.
& Martin D. Zielinski [email protected]
Victor Kong [email protected]
Michael D. Traynor Jr [email protected]
Damian Clarke [email protected]
Matthew C. Hernandez [email protected]
John A. Harvin [email protected]
Johnathon M. Aho [email protected] Kevin Wise [email protected]
1
Division of Trauma, Critical Care and General Surgery, St. Mary’s Hospital, Mayo Clinic, Mary Brigh 2-810, 1216 Second Street SW, Rochester, MN 55902, USA
123
World J Surg
Keywords Trauma Low- and middle-income countries Damage control surgery Damage control laparotomy Damage control resuscitation
Introduction When injury overwhelms physiology, surgery should be abbre
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