The effective risk factors on mortality in patients undergoing damage control surgery

M. Kapan, A. Onder, A. Oguz, F. Taskesen, I. Aliosmanoglu, M. Gul, I. Tacyildiz

Department of General Surgery, School of Medicine, Dicle University, Diyarbakir, Turkey. drmuratkapan@gmail.com

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• Surgery

BACKGROUND: Damage control surgery is a life-saving procedure used in fatal injuries. Morbidity and mortality rate are high in these patients due to massive trauma. The aim of this study was to analyze the risk factors associated with mortality in abdominal traumas that underwent damage control surgery.

PATIENTS AND METHODS: The retrospective study included 24 patients that underwent damage control surgery between January 2004 and September 2010. Age, gender, type of injury, period of time before admission, hemodynamic parameters, associated organ injury, injury severity score, surgical procedures performed, length of hospital stay, and complication and mortality rates were recorded.

RESULTS: The study included 16 (66.7%) men and 8 (33.3%) women, with a mean age of 32.3 years. Median period of time before admission was 30.83 minutes. All the patients were present with hypothermia and acidosis at admission, while only 5 of them were hemodynamically stable. Mean 6.75 units of blood were transfused in all of them. Common etiological factors included gunshot (50%) and motor vehicle accident (25%). Hepatic injury (83.3%) was the most common organ injury. Mean injury severity score (ISS) was 28.88. Damage control surgery was performed in all the patients. Skin-only closure was applied in 17 (70.8%), while 7 (29.2%) patients received Bogota bag application. Definitive surgery was achieved through de-packing over 36-48 hours in average. Total mortality occurred in 11 (45.8%) patients. Period of time before admission, core temperature at admission, pH levels and amount of blood transfusion were statistically different in the mortality group. A total of 16 complications occurred in 10 patients. Among these, intraabdominal abscess (46.2%) was the most common.

CONCLUSION: Hypothermia (< 35°C), acidosis (pH < 7.2), instability related to systolic blood pressure, massive blood transfusion, and delayed admission are predictive factors for mortality.

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