| Abstract: Objectives
The incorporation of damage control surgery (DCS) principles into the management of critically ill patients with non-traumatic pathology has been suggested (1). This study aims to assess the efficacy of this technique when used in combination with laparostomy formation (2) in cases of intra-abdominal sepsis (3).
Methods
A consecutive series of patients presenting with non-traumatic intra-abdominal sepsis, managed by DCS, were incorporated into a case control study. The control group comprised all patients with similar diagnosis who underwent standard surgical interventions and ICU admission during the same time period. Demographics, APACHE II score, predicted mortality, ICU and total post op stay, 30 day and hospital mortality were recorded prospectively.
Results
94 patients (17 cases; 77 controls) were recruited; 44 men and 50 women with a median age of 73.5. There was no significant difference in the APACHE II score between groups. The 30 day and hospital mortalities for cases : controls were 5.9% : 24.7% and 17.6% : 31.2%, respectively. The observed compared to predicted mortality was 3 : 2.8 and 24 : 16.4 for the case and control groups respectively (p=0.06). The mean length of ICU stay was significantly longer for cases than controls (13.8 : 7.1 days; p=0.025), although the overall hospital stays were equivalent (28.3 : 29.2 days; p=0.89).
Conclusions
Use of DCS in this patient group would appear equivalent if not superior, in terms of survival, when compared to existing management strategies. The need for increased critical care capacity, if this is to become mainstream practice, is clear. |
