A. A. Smith1, C. Guidry1, P. McGrew1, J. Friedman1, R. Schroll1, C. McGinness1, J. Duchesne1 1Tulane University,Surgery,New Orleans, LA, USA
Introduction: Damage Control Laparotomy (DCL) is an integral component in the immediate management of critically ill trauma patients to control hemorrhage and intra-abdominal contamination. Patients of advanced age have less physiologic reserve and an altered response to traumatic injuries when compared to younger patients. As the population in the United States continues to age, the number of DCLs in patients of advanced age will ultimately increase. There is a paucity of literature on outcomes for older patients managed with DCL. The objective of this study was to provide evidence for outcomes in older population who received DCL for trauma.
Methods: A retrospective chart review of consecutive adult patients with DCL for abdominal trauma at a Level I trauma center was conducted from 2012-2017. The patients were stratified into two groups, advanced age (AA) for patients 40 years and older and younger age (YA) for patients less than 40 years of age.
Results: A total of 149 patients with DCLs were identified with an average age of 34.0 (range, 19-81 years). In regards to patient demographics, there was no difference in ISS (p=0.16), mechanism (p=0.44), and initial INR (p=1.0). The AA group did, however, have significantly lower ED SBP (p=0.01) and significantly higher initial fibrinogen (p<0.0001). When analyzing outcomes and interventions, AA patients received MTP more frequently (p=0.03). There was a trend toward increased mortality in the AA group (23% vs 11%) when compared to YA group, though this did not reach significance (p=0.08). Of significance, the AA group had an overall shorter time to mortality (4.5+0.4 vs 8.9+1.2 days, p=0.02).
Conclusion: With an aging population, it is likely that the number of DCLs in older patients will increase. AA patients managed with DCL had decreased initial ED SBP with more utilization of MTP resources and overall shorter time to mortality. Future research should emphasize strategies that will develop optimal management and resource utilization of older trauma patients.
