Direct peritoneal resuscitation in trauma patients results in similar rate of intra-abdominal infectious complications

Author(s):
JACOB EDWARDS; Marissa Bare-Burchette; Nathaniel Poulin; William Irish; Eric A Toschlog

Background: Trauma patients undergoing damage control surgery (DCS) have a propensity for complicated abdominal closures and intra-abdominal complications. Studies show that management of open abdomens with direct peritoneal resuscitation (DPR) reduces intra-abdominal complications and accelerates abdominal closure. This novel study evaluates intra-abdominal complication rates and the effect of when DPR is initiated on patient outcomes.
Hypothesis: Intra-abdominal complications such as abscesses, fistulae, and hernias would be reduced with the use of DPR in the trauma patient.
Methods: A retrospective chart review was performed on 120 patients who underwent DCS. Fifty patients were identified as DCS with DPR, and compared to 70 controls who were similar by gender, race, age, BMI, past medical history, mechanism of trauma, and injury severity score.
Results: The two groups of patients “-DPR” and “+DPR” were similar in their clinicodemographics. The +DPR group was more likely to have a mesh closure than the –DPR (14% and 3%; p=0.022). The +DPR group had a longer interval to final closure (3.5±2.6 days vs 2.5±1.8; p=0.020). Infectious complications and mechanical failure of the closure technique were similar among the two groups. Delayed initiation had no effect on closure type but did increase the number of days to closure (initiation at first operation 2.8±1.8 days vs initiation at subsequent operations 6.0±3.3 days; p=<0.001).
Conclusions: The use of DPR did not result in different outcomes in trauma patients. Traditional DCS may not be inferior to DCS with DPR. When choosing to use DPR, initiating it at the first operation could significantly reduce the number days to closure.