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Damage Control Surgery for Non-traumatic Abdominal Emergencies

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Abstract

Background

Damage control surgery (DCS) was a major paradigm change in the management of critically ill trauma patients and has gradually expanded in the general surgery arena, but data in this setting are still scarce. The study aim was to evaluate outcomes of DCS in patients with general surgery emergencies.

Methods

Between 2005 and 2015, 164 patients (104 men, age 66) underwent DCS for non-traumatic abdominal emergencies. The decision to perform DCS was triggered by the presence of at least one trauma DCS criterion: hypotension (<70 mmHg), hypothermia (<35 °C), acidosis (pH < 7.25), coagulopathy (INR ≥ 1.7) and massive (>5 RBC) transfusion. Statistical tests were performed to identify risk factors for operative mortality. Observed outcomes were compared to those predicted by commonly employed scores (APACHE II, POSSUM, P-POSSUM, SAPS II).

Results

DCS was performed for acute mesenteric ischemia (n = 68), peritonitis (n = 44), pancreatitis (n = 28), bleeding (n = 14) and other (n = 10). Abdominal compartment syndrome was associated in 52 patients (32%). Seventy-four (45%) patients died and 150 patients (91%) experienced complications. On multivariate analysis, age (p = 0.018) and INR ≥ 1.7 (p = 0.001) were independent predictors of mortality. Mortality was 24% (13/55), 48% (22/46) and 62% (39/63) in patients with one, two and ≥3 DCS criteria, respectively. Comparison of observed and score-predicted mortality suggested DCS use resulted in significant survival benefit of the whole cohort and of patients with pancreatitis and postoperative peritonitis.

Conclusions

DCS can be lifesaving in critically ill patients with general surgery emergencies. Patients with peritonitis and acute pancreatitis are those who benefit most of the DCS approach.

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Authors and Affiliations

  1. Digestive and Emergency Surgery Department, Grenoble-Alpes University Hospital, Grenoble, France

    Edouard Girard, Julio Abba, Bertrand Trilling, Adrian Mancini, Christian Létoublon, Mircea Chirica & Catherine Arvieux

  2. TIMC Research Unit, CNRS, Grenoble-Alpes University, Grenoble, France

    Edouard Girard, Bastien Boussat & Bertrand Trilling

  3. Quality of Care Unit, Grenoble-Alpes University Hospital, Grenoble, France

    Bastien Boussat

  4. Anesthesiology and Intensive Care Medicine, Grenoble-Alpes University Hospital, Grenoble, France

    Pierre Bouzat

  5. Service de Chirurgie Digestive et Générale, Hôpital Michallon, Centre Hospitalier Universitaire Grenoble-Alpes, Boulevard de la Chantourne, 38700, Grenoble, La Tronche, France

    Edouard Girard

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  1. Edouard Girard
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Correspondence to Edouard Girard.

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Girard, E., Abba, J., Boussat, B. et al. Damage Control Surgery for Non-traumatic Abdominal Emergencies. World J Surg 42, 965–973 (2018). https://doi.org/10.1007/s00268-017-4262-6

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  • DOI: https://doi.org/10.1007/s00268-017-4262-6

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