Primary fascial closure after damage control laparotomy: sepsis vs haemorrhage.

Abstract

To compare the outcomes of patients undergoing damage control laparotomy (DCL) for intra-abdominal sepsis vs intra abdominal haemorrhage. We hypothesize that patients undergoing DCL for sepsis will have a higher rate of septic complications and a lower rate of primary fascial closure. Retrospective study of patients undergoing DCL from December 2006 to November 2009. Data are presented as medians and percentages where appropriate. 111 patients were identified (55 men), 79 with sepsis and 32 with haemorrhage. There was no difference in age (63 vs 62 years), body mass index (BMI, 27 vs 28), diabetes mellitus (13% vs 9%), or duration of initial operation (125 vs 117 min). Patients with sepsis presented with a lower serum lactate (2.2 vs 4.7 mmol/L, p<0.01), base deficit (4.0 vs 8.0, p ≤ 0.01) and ASA score (3.0 vs 4.0, p<0.01). There was no statistical difference in overall morbidity (81% vs 66), mortality (19% vs 22%), intra-abdominal abscess (18% vs 16%), deep wound infection (9% vs 9%), enterocutaneous fistula (ECF) (8% vs 6%) and primary fascial closure (58% vs 59%). Multivariable analysis demonstrated that intra-abdominal abscess (OR 4.26, 95% CI 1.06-19.32), higher base deficit (OR 1.14, 95% CI 1.00-1.31) and more abdominal explorations (OR 1.54, 95% CI 1.23-2.07) were associated with lack of primary fascial closure, but BMI (OR 1.00, 95% CI 0.94-1.07), ECF (OR 2.02, 95% CI 0.23-19.98), wound infection (OR 0.93, 95% CI 0.15-5.27), amount of crystalloids infused within the first 24h (OR 1.00, 95% CI 0.99-1.00) and intra-abdominal sepsis (OR 1.14, 95% CI 0.35-3.80) were not. There was an equivalent rate of septic complications and primary fascial closure rates regardless of cause for DCL. Intra-abdominal abscess, worse base deficit and higher number of abdominal explorations were independently associated with the lack of primary fascial closure.