Details der Publikation - Time is domain: factors affecting primary fascial closure after trauma and non-trauma damage control laparotomy (data from the EAST SLEEP-TIME multicenter registry)

Time is domain: factors affecting primary fascial closure after trauma and non-trauma damage control laparotomy (data from the EAST SLEEP-TIME multicenter registry)

Purpose Damage control laparotomy (DCL) is used for both traumatic and non-traumatic indications. Failure to achieve primary fascial closure (PFC) in a timely fashion has been associated with complications including sepsis, fistula, and mortality. We sought to identify factors associated with time to PFC in a multicenter retrospective cohort. Methods We reviewed retrospective data from 15 centers in the EAST SLEEP-TIME registry, including age, comorbidities (Charlson Comorbidity Index [CCI]), small and large bowel resection, bowel discontinuity, vascular procedures, retained packs, number of re-laparotomies, net fluid balance after 24 h, trauma, and time to first takeback in 12-h increments to identify key factors associated with time to PFC. Results In total, 368 patients (71.2% trauma, of which 50.6% were penetrating, median ISS 25 [16, 34], with median Apache II score 15 [11, 22] in non-trauma) were in the cohort. Of these, 92.9% of patients achieved PFC at 60.8 ± 72.0 h after 1.6 ± 1.2 re-laparotomies. Each additional re-laparotomy reduced the odds of PFC by 91.5% (95%CI 88.2–93.9%, p < 0.001). Time to first re-laparotomy was highly significant (p < 0.001) in terms of odds of achieving PFC, with no difference between 12 and 24 h to first re-laparotomy (ref), and decreases in odds of PFC of 78.4% (65.8–86.4%, p < 0.001) for first re-laparotomy after 24.1–36 h, 90.8% (84.7–94.4%, p < 0.001) for 36.1–48 h, and 98.1% (96.4–99.0%, p < 0.001) for > 48 h. Trauma patients had increased likelihood of PFC in two separate analyses (p = 0.022 and 0.002). Conclusion Time to re-laparotomy ≤ 24 h and minimizing number of re-laparotomies are highly predictive of rapid achievement of PFC in patients after trauma- and non-trauma DCL. Level of evidence 2B..

Medienart:	E-Artikel

Erscheinungsjahr:	2021
Erschienen:	2021

Enthalten in:	Zur Gesamtaufnahme - volume:48
Enthalten in:	European journal of trauma and emergency surgery - 48(2021), 3 vom: 29. Nov., Seite 2107-2116

Sprache:	Englisch

Beteiligte Personen:	Kwon, Eugenia [VerfasserIn] Krause, Cassandra [VerfasserIn] Luo-Owen, Xian [VerfasserIn] McArthur, Kaitlin [VerfasserIn] Cochran-Yu, Meghan [VerfasserIn] Swentek, Lourdes [VerfasserIn] Burruss, Sigrid [VerfasserIn] Turay, David [VerfasserIn] Krasnoff, Chloe [VerfasserIn] Grigorian, Areg [VerfasserIn] Nahmias, Jeffrey [VerfasserIn] Butt, Ahsan [VerfasserIn] Gutierrez, Adam [VerfasserIn] LaRiccia, Aimee [VerfasserIn] Kincaid, Michelle [VerfasserIn] Fiorentino, Michele [VerfasserIn] Glass, Nina [VerfasserIn] Toscano, Samantha [VerfasserIn] Ley, Eric Jude [VerfasserIn] Lombardo, Sarah [VerfasserIn] Guillamondegui, Oscar [VerfasserIn] Bardes, James Migliaccio [VerfasserIn] DeLa’O, Connie [VerfasserIn] Wydo, Salina [VerfasserIn] Leneweaver, Kyle [VerfasserIn] Duletzke, Nicholas [VerfasserIn] Nunez, Jade [VerfasserIn] Moradian, Simon [VerfasserIn] Posluszny, Joseph [VerfasserIn] Naar, Leon [VerfasserIn] Kaafarani, Haytham [VerfasserIn] Kemmer, Heidi [VerfasserIn] Lieser, Mark [VerfasserIn] Hanson, Isaac [VerfasserIn] Chang, Grace [VerfasserIn] Bilaniuk, Jaroslaw W. [VerfasserIn] Nemeth, Zoltan [VerfasserIn] Mukherjee, Kaushik [VerfasserIn]

Links:	Volltext [lizenzpflichtig]

BKL:	44.80$jUnfallmedizin$jNotfallmedizin 44.65$jChirurgie
Themen:	Damage control laparotomy Non-trauma Primary fascial closure Trauma

Anmerkungen:	© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2021

doi:	10.1007/s00068-021-01814-w

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	OLC2130879209

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520			\|a Purpose Damage control laparotomy (DCL) is used for both traumatic and non-traumatic indications. Failure to achieve primary fascial closure (PFC) in a timely fashion has been associated with complications including sepsis, fistula, and mortality. We sought to identify factors associated with time to PFC in a multicenter retrospective cohort. Methods We reviewed retrospective data from 15 centers in the EAST SLEEP-TIME registry, including age, comorbidities (Charlson Comorbidity Index [CCI]), small and large bowel resection, bowel discontinuity, vascular procedures, retained packs, number of re-laparotomies, net fluid balance after 24 h, trauma, and time to first takeback in 12-h increments to identify key factors associated with time to PFC. Results In total, 368 patients (71.2% trauma, of which 50.6% were penetrating, median ISS 25 [16, 34], with median Apache II score 15 [11, 22] in non-trauma) were in the cohort. Of these, 92.9% of patients achieved PFC at 60.8 ± 72.0 h after 1.6 ± 1.2 re-laparotomies. Each additional re-laparotomy reduced the odds of PFC by 91.5% (95%CI 88.2–93.9%, p < 0.001). Time to first re-laparotomy was highly significant (p < 0.001) in terms of odds of achieving PFC, with no difference between 12 and 24 h to first re-laparotomy (ref), and decreases in odds of PFC of 78.4% (65.8–86.4%, p < 0.001) for first re-laparotomy after 24.1–36 h, 90.8% (84.7–94.4%, p < 0.001) for 36.1–48 h, and 98.1% (96.4–99.0%, p < 0.001) for > 48 h. Trauma patients had increased likelihood of PFC in two separate analyses (p = 0.022 and 0.002). Conclusion Time to re-laparotomy ≤ 24 h and minimizing number of re-laparotomies are highly predictive of rapid achievement of PFC in patients after trauma- and non-trauma DCL. Level of evidence 2B.
650		4	\|a Trauma
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Time is domain: factors affecting primary fascial closure after trauma and non-trauma damage control laparotomy (data from the EAST SLEEP-TIME multicenter registry)

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