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Status quo of the use of DCS concepts and outcome with focus on blunt abdominal trauma

A registry-based analysis from the TraumaRegister DGU®

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Abstract

Introduction

Damage control surgery (DCS) is a standardized treatment concept in severe abdominal injury. Despite its evident advantages, DCS bears the risk of substantial morbidity and mortality, due to open abdomen therapy (OAT). Thus, identifying the suitable patients for that approach is of utmost importance. Furthermore, little is known about the use of DCS and the related outcome, especially in blunt abdominal trauma.

Methods

Patients recorded in the TraumaRegister DGU® from 2008 to 2017, and with an Injury Severity Score (ISS) ≥ 9 and an abdominal injury with an Abbreviated Injury Scale (AIS) score ≥ 3 were included in that registry-based analysis. Patients with DCS and temporary abdominal closure (TAC) were compared with patients who were treated with a laparotomy and primary closure (non-DCS) and those who did receive non-operative management (NOM). Following descriptive analysis, a matched-pairs study was conducted to evaluate differences and outcomes between DCS and non-DCS group. Matching criteria were age, abdominal trauma severity, and hemodynamical instability at the scene.

Results

The injury mechanism was predominantly blunt (87.1%). Of the 8226 patients included, 2351 received NOM, 5011 underwent laparotomy and primary abdominal closure (non-DCS), and 864 were managed with DCS. Thus, 785 patient pairs were analysed. The rate of hepatic injuries AIS > 3 differed between the groups (DCS 50.3% vs. non-DCS 18.1%). DCS patients had a higher ISS (p = 0.023), required more significant volumes of fluids, more catecholamines, and transfusions (p < 0.001). More DCS patients were in shock at the accident scene (p = 0.022). DCS patients had a higher number of severe hepatic (AIS score ≥ 3) and gastrointestinal injuries and more vascular injuries. Most severe abdominal injuries in non-DCS patients were splenic injuries (AIS, 4 and 5) (52.1% versus 37.9%, p = 0.004).

Conclusion

DCS is a strategy used in unstable trauma patients, severe hepatic, gastrointestinal, multiple abdominal injuries, and mass transfusions. The expected survival rates were achieved in such extreme trauma situations.

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Availability of data and material

Datasheets and analysis are made available upon request to the corresponding author.

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Acknowledgements

We would like to thank the members of the Polytrauma Study Group of the German Trauma Society (DGU®) for their many years of hard work and commitment to TraumaRegister DGU®. In 2007, the Polytrauma Study Group was integrated into the Committee on Emergency Medicine, Intensive Care, and Trauma Management (Sektion NIS) of the German Trauma Society (DGU). We would also like to thank the German Office of Languages in Hürth for linguistic support. We thank the hospitals that contributed data to TraumaRegister DGU® for their commitment.

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Authors and Affiliations

  1. Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany

    Arnulf Willms, Christoph Güsgen, Robert Schwab & Sebastian Schaaf

  2. Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany

    Rolf Lefering

  3. Department of General, Transplantation, Vascular and Paediatric Surgery, University Hospital of Würzburg, VisceralWürzburg, Germany

    Johan Lock

  4. Department of Orthopaedics, Trauma Surgery, Reconstructive Surgery, Hand Surgery, Plastic Surgery, and Burn Medicine, German Armed Forces Central Hospital, Koblenz, Germany

    Erwin Kollig & Dan Bieler

  5. Department of Anesthesiology and Intensive Care, German Armed Forces Central Hospital, Koblenz, Germany

    Christoph Jänig

  6. Department of Orthopaedics and Trauma Surgery, Heinrich Heine University Medical School, Düsseldorf, Germany

    Dan Bieler

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  1. Arnulf Willms
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the Committee on Emergency Medicine, Intensive Care, Trauma Management (Sektion N. I. S.) of the German Trauma Society (DGU)

Corresponding author

Correspondence to Christoph Güsgen.

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Ethics approval

The study was performed following the current publication guideline of the TraumaRegister DGU® and is registered as TR-DGU Project ID 2018–049. Since the study was a retrospective analysis based on aggregated routine data, ethical approval was not required according to the responsible regional medical association (Ethikkommission der Landesärztekammer Rheinland-Pfalz, Mainz, Germany). This study was registered in the German Clinical Trials Register (DRKS) in accordance with the ICMJE requirements (ID: DRKS00023988).

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Patients agreed on study participation and data publication as informed consent of entering the data into TraumaRegister DGU® has been obtained.

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The authors declare no competing interests.

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Willms, A., Güsgen, C., Schwab, R. et al. Status quo of the use of DCS concepts and outcome with focus on blunt abdominal trauma. Langenbecks Arch Surg 407, 805–817 (2022). https://doi.org/10.1007/s00423-021-02344-0

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