Intestinal discontinuity may be associated with worse outcomes in damage control laparotomy for trauma: An American association for the surgery of trauma prospective multicenter observational study

Abstract

Introduction: In damage control laparotomy (DCL) for trauma, intestinal injuries are often left in discontinuity. This study compared outcomes in patients with intestinal discontinuity versus immediate anastomosis.

Methods: Prospective multicenter, AAST study, included patients requiring DCL with intestinal resection. Patients were categorized into bowel Discontinuity and Continuity groups. Data collection included clinical characteristics, injury severity, peritoneal contamination, intraoperative blood products, crystalloids and vasopressors, operative time, takeback operative findings, fascia closure and postoperative complications. Outcomes included mortality, bowel ischemia, postoperative complications, fascia closure, and hospital stay.

Results: 246 patients from 16 centers. Using propensity score matching, 132 patients in the Discontinuity group were well-matched with 66 in the Continuity group. Discontinuity was associated with significantly higher mortality and septic complications. Fascia closure was more likely to be achieved in the Continuity group at the 2nd takeback operation.

Conclusions: Intestinal discontinuity in DCL is associated with increased mortality and septic complications.