Trauma and nontrauma damage-control laparotomy : The difference is delirium (data from the Eastern Association for the Surgery of Trauma SLEEP-TIME multicenter trial)
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved..
BACKGROUND: Damage-control laparotomy (DCL) has been used for traumatic and nontraumatic indications. We studied factors associated with delirium and outcome in this population.
METHODS: We reviewed DCL patients at 15 centers for 2 years, including demographics, Charlson Comorbidity Index (CCI), diagnosis, operations, and outcomes. We compared 30-day mortality; renal failure requiring dialysis; number of takebacks; hospital, ventilator, and intensive care unit (ICU) days; and delirium-free and coma-free proportion of the first 30 ICU days (DF/CF-ICU-30) between trauma (T) and nontrauma (NT) patients. We performed linear regression for DF/CF-ICU-30, including age, sex, CCI, achievement of primary fascial closure (PFC), small and large bowel resection, bowel discontinuity, abdominal vascular procedures, and trauma as covariates. We performed one-way analysis of variance for DF/CF-ICU-30 against traumatic brain injury severity as measured by Abbreviated Injury Scale for the head.
RESULTS: Among 554 DCL patients (25.8% NT), NT patients were older (58.9 ± 15.8 vs. 39.7 ± 17.0 years, p < 0.001), more female (45.5% vs. 22.1%, p < 0.001), and had higher CCI (4.7 ± 3.3 vs. 1.1 ± 2.2, p < 0.001). The number of takebacks (1.7 ± 2.6 vs. 1.5 ± 1.2), time to first takeback (32.0 hours), duration of bowel discontinuity (47.0 hours), and time to PFC were similar (63.2 hours, achieved in 73.5%). Nontrauma and T patients had similar ventilator, ICU, and hospital days and mortality (31.0% NT, 29.8% T). Nontrauma patients had higher rates of renal failure requiring dialysis (36.6% vs. 14.1%, p < 0.001) and postoperative abdominal sepsis (40.1% vs. 17.1%, p < 0.001). Trauma and NT patients had similar number of hours of sedative (89.9 vs. 65.5 hours, p = 0.064) and opioid infusions (106.9 vs. 96.7 hours, p = 0.514), but T had lower DF/CF-ICU-30 (51.1% vs. 73.7%, p = 0.029), indicating more delirium. Linear regression analysis indicated that T was associated with a 32.1% decrease (95% CI, 14.6%-49.5%; p < 0.001) in DF/CF-ICU-30, while achieving PFC was associated with a 25.1% increase (95% CI, 10.2%-40.1%; p = 0.001) in DF/CFICU-30. Increasing Abbreviated Injury Scale for the head was associated with decreased DF/CF-ICU-30 by analysis of variance (p < 0.001).
CONCLUSION: Nontrauma patients had higher incidence of postoperative abdominal sepsis and need for dialysis, while T was independently associated with increased delirium, perhaps because of traumatic brain injury.
LEVEL OF EVIDENCE: Therapeutic study, level IV.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:91 |
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| Enthalten in: |
The journal of trauma and acute care surgery - 91(2021), 1 vom: 01. Juli, Seite 100-107 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
McArthur, Kaitlin [VerfasserIn] |
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| Links: |
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| Themen: |
Analgesics, Opioid |
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| Anmerkungen: |
Date Completed 23.09.2021 Date Revised 25.08.2023 published: Print Citation Status MEDLINE |
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| doi: |
10.1097/TA.0000000000003210 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM326920536 |
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| 100 | 1 | |a McArthur, Kaitlin |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Trauma and nontrauma damage-control laparotomy |b The difference is delirium (data from the Eastern Association for the Surgery of Trauma SLEEP-TIME multicenter trial) |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 23.09.2021 | ||
| 500 | |a Date Revised 25.08.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Damage-control laparotomy (DCL) has been used for traumatic and nontraumatic indications. We studied factors associated with delirium and outcome in this population | ||
| 520 | |a METHODS: We reviewed DCL patients at 15 centers for 2 years, including demographics, Charlson Comorbidity Index (CCI), diagnosis, operations, and outcomes. We compared 30-day mortality; renal failure requiring dialysis; number of takebacks; hospital, ventilator, and intensive care unit (ICU) days; and delirium-free and coma-free proportion of the first 30 ICU days (DF/CF-ICU-30) between trauma (T) and nontrauma (NT) patients. We performed linear regression for DF/CF-ICU-30, including age, sex, CCI, achievement of primary fascial closure (PFC), small and large bowel resection, bowel discontinuity, abdominal vascular procedures, and trauma as covariates. We performed one-way analysis of variance for DF/CF-ICU-30 against traumatic brain injury severity as measured by Abbreviated Injury Scale for the head | ||
| 520 | |a RESULTS: Among 554 DCL patients (25.8% NT), NT patients were older (58.9 ± 15.8 vs. 39.7 ± 17.0 years, p < 0.001), more female (45.5% vs. 22.1%, p < 0.001), and had higher CCI (4.7 ± 3.3 vs. 1.1 ± 2.2, p < 0.001). The number of takebacks (1.7 ± 2.6 vs. 1.5 ± 1.2), time to first takeback (32.0 hours), duration of bowel discontinuity (47.0 hours), and time to PFC were similar (63.2 hours, achieved in 73.5%). Nontrauma and T patients had similar ventilator, ICU, and hospital days and mortality (31.0% NT, 29.8% T). Nontrauma patients had higher rates of renal failure requiring dialysis (36.6% vs. 14.1%, p < 0.001) and postoperative abdominal sepsis (40.1% vs. 17.1%, p < 0.001). Trauma and NT patients had similar number of hours of sedative (89.9 vs. 65.5 hours, p = 0.064) and opioid infusions (106.9 vs. 96.7 hours, p = 0.514), but T had lower DF/CF-ICU-30 (51.1% vs. 73.7%, p = 0.029), indicating more delirium. Linear regression analysis indicated that T was associated with a 32.1% decrease (95% CI, 14.6%-49.5%; p < 0.001) in DF/CF-ICU-30, while achieving PFC was associated with a 25.1% increase (95% CI, 10.2%-40.1%; p = 0.001) in DF/CFICU-30. Increasing Abbreviated Injury Scale for the head was associated with decreased DF/CF-ICU-30 by analysis of variance (p < 0.001) | ||
| 520 | |a CONCLUSION: Nontrauma patients had higher incidence of postoperative abdominal sepsis and need for dialysis, while T was independently associated with increased delirium, perhaps because of traumatic brain injury | ||
| 520 | |a LEVEL OF EVIDENCE: Therapeutic study, level IV | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 7 | |a Analgesics, Opioid |2 NLM | |
| 700 | 1 | |a Krause, Cassandra |e verfasserin |4 aut | |
| 700 | 1 | |a Kwon, Eugenia |e verfasserin |4 aut | |
| 700 | 1 | |a Luo-Owen, Xian |e verfasserin |4 aut | |
| 700 | 1 | |a Cochran-Yu, Meghan |e verfasserin |4 aut | |
| 700 | 1 | |a Swentek, Lourdes |e verfasserin |4 aut | |
| 700 | 1 | |a Burruss, Sigrid |e verfasserin |4 aut | |
| 700 | 1 | |a Turay, David |e verfasserin |4 aut | |
| 700 | 1 | |a Krasnoff, Chloe |e verfasserin |4 aut | |
| 700 | 1 | |a Grigorian, Areg |e verfasserin |4 aut | |
| 700 | 1 | |a Nahmias, Jeffry |e verfasserin |4 aut | |
| 700 | 1 | |a Butt, Ahsan |e verfasserin |4 aut | |
| 700 | 1 | |a Gutierrez, Adam |e verfasserin |4 aut | |
| 700 | 1 | |a LaRiccia, Aimee |e verfasserin |4 aut | |
| 700 | 1 | |a Kincaid, Michelle |e verfasserin |4 aut | |
| 700 | 1 | |a Fiorentino, Michele N |e verfasserin |4 aut | |
| 700 | 1 | |a Glass, Nina |e verfasserin |4 aut | |
| 700 | 1 | |a Toscano, Samantha |e verfasserin |4 aut | |
| 700 | 1 | |a Ley, Eric |e verfasserin |4 aut | |
| 700 | 1 | |a Lombardo, Sarah R |e verfasserin |4 aut | |
| 700 | 1 | |a Guillamondegui, Oscar D |e verfasserin |4 aut | |
| 700 | 1 | |a Bardes, James M |e verfasserin |4 aut | |
| 700 | 1 | |a DeLa'O, Connie |e verfasserin |4 aut | |
| 700 | 1 | |a Wydo, Salina M |e verfasserin |4 aut | |
| 700 | 1 | |a Leneweaver, Kyle |e verfasserin |4 aut | |
| 700 | 1 | |a Duletzke, Nicholas T |e verfasserin |4 aut | |
| 700 | 1 | |a Nunez, Jade |e verfasserin |4 aut | |
| 700 | 1 | |a Moradian, Simon |e verfasserin |4 aut | |
| 700 | 1 | |a Posluszny, Joseph |e verfasserin |4 aut | |
| 700 | 1 | |a Naar, Leon |e verfasserin |4 aut | |
| 700 | 1 | |a Kaafarani, Haytham |e verfasserin |4 aut | |
| 700 | 1 | |a Kemmer, Heidi |e verfasserin |4 aut | |
| 700 | 1 | |a Lieser, Mark J |e verfasserin |4 aut | |
| 700 | 1 | |a Dorricott, Alexa |e verfasserin |4 aut | |
| 700 | 1 | |a Chang, Grace |e verfasserin |4 aut | |
| 700 | 1 | |a Nemeth, Zoltan |e verfasserin |4 aut | |
| 700 | 1 | |a Mukherjee, Kaushik |e verfasserin |4 aut | |
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