Damage control laparatomy for abdominal gunshot wounds: indications, mortality and long term outcomes

Background: Outcomes of patients subjected to damage control laparotomy (DCL) for abdominal gunshot wounds (GSWs) remains relatively unknown. There is limited evidence as to which variables may reliably predict morbidity and mortality. The aim of this study was to evaluate the impact of DCL on long term morbidity and survival, to determine clinical characteristics associated with increased mortality, and to evaluate the indications for DCL in patients with abdominal GSWs. Methods: A retrospective study of patients who underwent a damage control laparotomy for abdominal GSWs at Groote Schuur Hospital (GSH) was conducted. Data was collected on 50 consecutive trauma patients over a 4.5 years period (between August 1st, 2004 and September 30th, 2009). Patients were stratified by, age, preoperative and intraoperative physiological parameters, trauma indices, numbers and locations of abdominal GSWs, extra abdominal involvement, intensive care unit and hospital length of stay, morbidity and mortality. Unadjusted and adjusted estimates of the association between these factors and the odds of survival were computed with univariate and multivariate logistic regression. Results: Most of the patients were male (96%) with a mean age 29.7 year. Most patients had a single abdominal gunshot wound (60%). Liver injuries were the most common injury (58%) followed by small bowel (44%), 20 majors venous (40%), and colonic injury (38%) injuries. The overall mortality was 54%. The mean of length stay in the intensive care unit was 7 days with overall mean hospital length of stay of 13 days. Factor an associated with a decreased odd of survival included Penetrating abdominal trauma index(PATI) >25, pre-operative infusion of less than two litres of crystalloids, intra-operative blood lactate level >8mmol/L, massive transfusion >10 units PRBCs. Conclusion: The overall mortality of patients requiring DCL for abdominal GSWs was 54%. In this limited study, there is significant evidence that after controlling for confounding PATI score of >25 is associated with a decreased odds of survival (OR:0.20, p-value 0.04)