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February 24, 2016World Journal of Emergency SurgeryOpen Access

Damage control operations in non-trauma patients: defining criteria for the staged rapid source control laparotomy in emergency general surgery

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Key result

Staged rapid source control laparotomy in emergency general surgery patients was associated with a 45.3% in-hospital mortality compared to 20.4% for non-staged laparotomy, and trauma lethal triad criteria did not independently predict survival.

Why the study?

Does staged rapid source control laparotomy (RSCL) improve survival compared to non-RSCL in emergency general surgery patients?

Population

215 emergency general surgery (EGS) patients undergoing emergent laparotomy over 3 years

Comparison

Staged rapid source control laparotomy (RSCL) vs Non-RSCL emergent laparotomy

Design

Cohort

Authors

RBRobert D. BecherUniversity of North Carolina at Chapel HillAPAndrew B. PeitzmanUniversity of PittsburghJSJason L. SperryUniversity of Pittsburgh

Discussion

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Implication

Staged RSCL should not yet change practice in emergency general surgery; leaves open potential mortality benefit in select patients with severe sepsis, acidosis, and comorbidities.

Study Design

Type

Cohort (n=215)

Multicenter

No

Structured PICO

Does staged rapid source control laparotomy (RSCL) improve survival compared to non-RSCL in emergency general surgery patients?

P
Population
215 emergency general surgery patients undergoing emergent, non-trauma related open laparotomies with colon or small bowel resections, evaluated for in-hospital mortality.
I
Intervention
Staged rapid source control laparotomy (RSCL)
C
Comparator
Non-RSCL emergent laparotomy
O
Outcome
Mortality and postoperative complicationshard clinical

Main Result

Absolute Event Rate: 45.3% vs 20.4%

p-value: p=0.0004

The lethal triad used in trauma may not confer a survival advantage in emergency general surgery; instead, indications for staged RSCL should include severe sepsis/septic shock, elevated lactate, acidosis, male gender, advanced age, and pre-existing comorbidities.

Limitations

  • Retrospective data constrained by selection bias
  • Definition of an emergency patient is a construct of the study and individual assessments
  • Data are from a single tertiary medical center and may not be representative of a national sample
  • Small sample size of 215 patients lacking statistical power
  • Potential unmeasured peri-operative risk factors and physiologic variables

Cite This Study

Becher et al. (2016) conducted a cohort in Emergency general surgery requiring emergent laparotomy (n=215). Staged rapid source control laparotomy (RSCL) vs. Non-staged laparotomy (non-RSCL) was evaluated on In-hospital mortality (p=0.0004). Staged rapid source control laparotomy in emergency general surgery patients was associated with a 45.3% in-hospital mortality compared to 20.4% for non-staged laparotomy, and trauma lethal triad criteria did not independently predict survival.

synapsesocial.com/papers/6a9518fcaa92d0f3572c93e6https://doi.org/10.1186/s13017-016-0067-4
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