Abstract
Background
Damage control laparotomy emphasizes physiologic stabilization of critically injured
patients and allows staged surgical management. However, there is little consensus
on the optimal criteria for damage control laparotomy. We examined variability between
centers and over time in Pennsylvania.
Methods
We analyzed the Pennsylvania Trauma Outcomes Study data between 2000 and 2018, excluding
centers performing <10 laparotomies/year. Laparotomy was defined using International
Classification of Diseases codes, and damage control laparotomy was defined by a code
for “reopening of recent laparotomy” or a return to the operating room >4 hours from
index laparotomy that was not unplanned. We examined trends over time and by center.
Multivariable logistic regression models were developed to predict both damage control
laparotomy and mortality, generate observed:expected ratios, and identify outliers
for each. We compared risk-adjusted mortality rates to center-level damage control
laparotomy rates.
Results
In total, 18,896 laparotomies from 22 centers were analyzed; 3,549 damage control
laparotomies were performed (18.8% of all laparotomies). The use of damage control
laparotomy in Pennsylvania varied from 13.9% to 22.8% over time. There was wide variation
in center-level use of damage control laparotomy, from 11.1% to 29.4%, despite adjustment.
Factors associated with damage control laparotomy included injury severity and admission
vital signs. Center identity improved the model as demonstrated by likelihood ratio
test (P < .001), suggesting differences in center-level practices. There was minimal correlation
between center-level damage control laparotomy use and mortality.
Conclusion
There is wide center-level variation in the use of damage control laparotomy among
centers, despite adjustment for patient factors. Damage control laparotomy is both
resource intensive and highly morbid; regional resources should be allocated to address
this substantial practice variation to optimize damage control laparotomy use.
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Article info
Publication history
Published online: December 13, 2022
Accepted:
November 15,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
