ArticleThe journal of trauma and acute care surgery2019
The impact of standardized protocol implementation for surgical damage control and temporary abdominal closure after emergent laparotomy.
Article in The journal of trauma and acute care surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 26 citations in OpenAlex.
- Hypertonic saline infusion does not improve the chance of primary fascial closure after damage control laparotomy: a randomized controlled trial.World journal of emergency surgery : WJES · 2023Trial
- Are Fewer Damage Control Laparotomies Associated with a Decrease in the Rate and Severity of Surgical Site Infections?Surgical infections · 2026Article
- Review
- Use of barium for diagnosis of colonic perforation leads to challenging barium peritonitis.Trauma surgery & acute care open · 2024Article
- Article
- National Assessment of Opportunities for Improvement in Preventable Trauma Deaths: A Mixed-Methods Study.Healthcare (Basel, Switzerland) · 2023Article
- Tertiary peritonitis: considerations for complex team-based care.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Review
- Single Center Retrospective Review of Post-laparotomy CT Abdomen and Pelvis Findings and Trends.Frontiers in radiology · 2022Article
- Difference between delayed anastomosis and early anastomosis in damage control laparotomy affecting the infusion volume and NPWT output volume: is infusion restriction necessary in delayed anastomosis? A single-center retrospective analysis.Trauma surgery & acute care open · 2022Article
- Damage control surgical management of combined small and large bowel injuries in penetrating trauma: Are ostomies still pertinent?Colombia medica (Cali, Colombia) · 2021Observational
- What's new in critical illness and injury science? Management of the open abdomen: Getting it together!International journal of critical illness and injury scienceArticle
Corrections and comments
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Authors and funding
10 authors at 1 institution in 1 country.
Funding
Abstract
backgroundTo standardize care and promote early fascial closure among patients undergoing emergent laparotomy and temporary abdominal closure (TAC), we developed a protocol addressing patient selection, operative technique, resuscitation strategies, and critical care provisions. We hypothesized that primary fascial closure rates would increase following protocol implementation with no difference in complication rates. STUDY
designWe performed a retrospective cohort analysis of 138 adult trauma and emergency general surgery patients who underwent emergent laparotomy and TAC, comparing protocol patients (n = 60) to recent historic controls (n = 78) who would have met protocol inclusion criteria. The protocol includes low-volume 3% hypertonic saline resuscitation, judicious wound vacuum fluid replacement, and early relaparotomy with sequential fascial closure. Demographics, baseline characteristics, illness severity, resuscitation course, operative management, and outcomes were compared. The primary outcome was fascial closure.
resultsBaseline characteristics, including age, American Society of Anesthesiologists class, and postoperative lactate levels, were similar between groups. Within 48 hours of initial laparotomy and TAC, protocol patients received significantly lower total intravenous fluid resuscitation volumes (9.7 vs. 11.4 L, p = 0.044) and exhibited higher serum osmolarity (303 vs. 293 mOsm/kg, p = 0.001). The interval between abdominal operations was significantly shorter following protocol implementation (28.2 vs. 32.2 hours, p = 0.027). The incidence of primary fascial closure was significantly higher in the protocol group (93% vs. 81%, p = 0.045, number needed to treat = 8.3). Complication rates were similar between groups.
conclusionsProtocol implementation was associated with lower crystalloid resuscitation volumes, a transient hyperosmolar state, shorter intervals between operations, and higher fascial closure rates with no difference in complications. LEVEL OF EVIDENCE: Therapeutic study, level IV.
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