Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy

Matthew J. Pommerening, Joseph J. Dubose, Martin D. Zielinski, Herb A. Phelan, Thomas M. Scalea, Kenji Inaba, George C. Velmahos, James F. Whelan, Charles E. Wade, John B. Holcomb, Bryan A. Cotton

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background Failure to achieve primary fascial closure (PFC) after damage control laparotomy is costly and carries great morbidity. We hypothesized that time from the initial laparotomy to the first take-back operation would be predictive of successful PFC. Methods Trauma patients managed with open abdominal techniques after damage control laparotomy were prospectively followed at 14 Level 1 trauma centers during a 2-year period. Time to the first take-back was evaluated as a predictor of PFC using hierarchical multivariate logistic regression analysis. Results A total of 499 patients underwent damage control laparotomy and were included in this analysis. PFC was achieved in 327 (65.5%) patients. Median time to the first take-back operation was 36 hours (interquartile range 24-48). After we adjusted for patient demographics, resuscitation volumes, and operative characteristics, increasing time to the first take-back was associated with a decreased likelihood of PFC. Specifically, each hour delay in return to the operating room (24 hours after initial laparotomy) was associated with a 1.1% decrease in the odds of PFC (odds ratio 0.989; 95% confidence interval 0.978-0.999; P =.045). In addition, there was a trend towards increased intra-abdominal complications in patients returning after 48 hours (odds ratio 1.80; 95% confidence interval 1.00-3.25; P =.05). Conclusion Data from this prospective, multicenter study demonstrate that delays in returning to the operating room after damage control laparotomy are associated with reductions in PFC. These findings suggest that emphasis should be placed on returning to the operating room within 24 hours after the initial laparotomy if possible (and no later than 48 hours).

Original languageEnglish (US)
Pages (from-to)431-438
Number of pages8
JournalSurgery (United States)
Volume156
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Laparotomy
Operating Rooms
Odds Ratio
Confidence Intervals
Trauma Centers
Resuscitation
Multicenter Studies
Logistic Models
Regression Analysis
Demography
Prospective Studies
Morbidity
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Pommerening, M. J., Dubose, J. J., Zielinski, M. D., Phelan, H. A., Scalea, T. M., Inaba, K., ... Cotton, B. A. (2014). Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy. Surgery (United States), 156(2), 431-438. https://doi.org/10.1016/j.surg.2014.04.019

Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy. / Pommerening, Matthew J.; Dubose, Joseph J.; Zielinski, Martin D.; Phelan, Herb A.; Scalea, Thomas M.; Inaba, Kenji; Velmahos, George C.; Whelan, James F.; Wade, Charles E.; Holcomb, John B.; Cotton, Bryan A.

In: Surgery (United States), Vol. 156, No. 2, 2014, p. 431-438.

Research output: Contribution to journalArticle

Pommerening, MJ, Dubose, JJ, Zielinski, MD, Phelan, HA, Scalea, TM, Inaba, K, Velmahos, GC, Whelan, JF, Wade, CE, Holcomb, JB & Cotton, BA 2014, 'Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy', Surgery (United States), vol. 156, no. 2, pp. 431-438. https://doi.org/10.1016/j.surg.2014.04.019
Pommerening, Matthew J. ; Dubose, Joseph J. ; Zielinski, Martin D. ; Phelan, Herb A. ; Scalea, Thomas M. ; Inaba, Kenji ; Velmahos, George C. ; Whelan, James F. ; Wade, Charles E. ; Holcomb, John B. ; Cotton, Bryan A. / Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy. In: Surgery (United States). 2014 ; Vol. 156, No. 2. pp. 431-438.
@article{54722afd3f1746ed86f44eaa8e9d6ec3,
title = "Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy",
abstract = "Background Failure to achieve primary fascial closure (PFC) after damage control laparotomy is costly and carries great morbidity. We hypothesized that time from the initial laparotomy to the first take-back operation would be predictive of successful PFC. Methods Trauma patients managed with open abdominal techniques after damage control laparotomy were prospectively followed at 14 Level 1 trauma centers during a 2-year period. Time to the first take-back was evaluated as a predictor of PFC using hierarchical multivariate logistic regression analysis. Results A total of 499 patients underwent damage control laparotomy and were included in this analysis. PFC was achieved in 327 (65.5{\%}) patients. Median time to the first take-back operation was 36 hours (interquartile range 24-48). After we adjusted for patient demographics, resuscitation volumes, and operative characteristics, increasing time to the first take-back was associated with a decreased likelihood of PFC. Specifically, each hour delay in return to the operating room (24 hours after initial laparotomy) was associated with a 1.1{\%} decrease in the odds of PFC (odds ratio 0.989; 95{\%} confidence interval 0.978-0.999; P =.045). In addition, there was a trend towards increased intra-abdominal complications in patients returning after 48 hours (odds ratio 1.80; 95{\%} confidence interval 1.00-3.25; P =.05). Conclusion Data from this prospective, multicenter study demonstrate that delays in returning to the operating room after damage control laparotomy are associated with reductions in PFC. These findings suggest that emphasis should be placed on returning to the operating room within 24 hours after the initial laparotomy if possible (and no later than 48 hours).",
author = "Pommerening, {Matthew J.} and Dubose, {Joseph J.} and Zielinski, {Martin D.} and Phelan, {Herb A.} and Scalea, {Thomas M.} and Kenji Inaba and Velmahos, {George C.} and Whelan, {James F.} and Wade, {Charles E.} and Holcomb, {John B.} and Cotton, {Bryan A.}",
year = "2014",
doi = "10.1016/j.surg.2014.04.019",
language = "English (US)",
volume = "156",
pages = "431--438",
journal = "Surgery (United States)",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy

AU - Pommerening, Matthew J.

AU - Dubose, Joseph J.

AU - Zielinski, Martin D.

AU - Phelan, Herb A.

AU - Scalea, Thomas M.

AU - Inaba, Kenji

AU - Velmahos, George C.

AU - Whelan, James F.

AU - Wade, Charles E.

AU - Holcomb, John B.

AU - Cotton, Bryan A.

PY - 2014

Y1 - 2014

N2 - Background Failure to achieve primary fascial closure (PFC) after damage control laparotomy is costly and carries great morbidity. We hypothesized that time from the initial laparotomy to the first take-back operation would be predictive of successful PFC. Methods Trauma patients managed with open abdominal techniques after damage control laparotomy were prospectively followed at 14 Level 1 trauma centers during a 2-year period. Time to the first take-back was evaluated as a predictor of PFC using hierarchical multivariate logistic regression analysis. Results A total of 499 patients underwent damage control laparotomy and were included in this analysis. PFC was achieved in 327 (65.5%) patients. Median time to the first take-back operation was 36 hours (interquartile range 24-48). After we adjusted for patient demographics, resuscitation volumes, and operative characteristics, increasing time to the first take-back was associated with a decreased likelihood of PFC. Specifically, each hour delay in return to the operating room (24 hours after initial laparotomy) was associated with a 1.1% decrease in the odds of PFC (odds ratio 0.989; 95% confidence interval 0.978-0.999; P =.045). In addition, there was a trend towards increased intra-abdominal complications in patients returning after 48 hours (odds ratio 1.80; 95% confidence interval 1.00-3.25; P =.05). Conclusion Data from this prospective, multicenter study demonstrate that delays in returning to the operating room after damage control laparotomy are associated with reductions in PFC. These findings suggest that emphasis should be placed on returning to the operating room within 24 hours after the initial laparotomy if possible (and no later than 48 hours).

AB - Background Failure to achieve primary fascial closure (PFC) after damage control laparotomy is costly and carries great morbidity. We hypothesized that time from the initial laparotomy to the first take-back operation would be predictive of successful PFC. Methods Trauma patients managed with open abdominal techniques after damage control laparotomy were prospectively followed at 14 Level 1 trauma centers during a 2-year period. Time to the first take-back was evaluated as a predictor of PFC using hierarchical multivariate logistic regression analysis. Results A total of 499 patients underwent damage control laparotomy and were included in this analysis. PFC was achieved in 327 (65.5%) patients. Median time to the first take-back operation was 36 hours (interquartile range 24-48). After we adjusted for patient demographics, resuscitation volumes, and operative characteristics, increasing time to the first take-back was associated with a decreased likelihood of PFC. Specifically, each hour delay in return to the operating room (24 hours after initial laparotomy) was associated with a 1.1% decrease in the odds of PFC (odds ratio 0.989; 95% confidence interval 0.978-0.999; P =.045). In addition, there was a trend towards increased intra-abdominal complications in patients returning after 48 hours (odds ratio 1.80; 95% confidence interval 1.00-3.25; P =.05). Conclusion Data from this prospective, multicenter study demonstrate that delays in returning to the operating room after damage control laparotomy are associated with reductions in PFC. These findings suggest that emphasis should be placed on returning to the operating room within 24 hours after the initial laparotomy if possible (and no later than 48 hours).

UR - http://www.scopus.com/inward/record.url?scp=84904256035&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84904256035&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2014.04.019

DO - 10.1016/j.surg.2014.04.019

M3 - Article

C2 - 24962190

AN - SCOPUS:84904256035

VL - 156

SP - 431

EP - 438

JO - Surgery (United States)

JF - Surgery (United States)

SN - 0039-6060

IS - 2

ER -