Applications of Damage Control Surgery in Modern Civilian Trauma Care

Abstract

Modern trauma damage control (DC) integrates the stages of DC surgery into the process of DC resuscitation. Although widely believed to improve survival when appropriately indicated, there is limited evidence supporting a benefit of DC surgery (and its component DC interventions) in injured patients. Further, the procedure is associated with a number of potentially severe and often resource-intensive complications. Several studies have recently reported data suggesting that a variation exists in the use of DC laparotomy across trauma centers or that the procedure may be overused. These and other studies have also suggested that overutilization of the procedure may be associated with increased morbidity and mortality. Variation in the use of DC surgery between trauma centers may occur because surgeons are frequently uncertain which “operative profile” (i.e., DC or definitive surgery) is best in varying clinical situations. In this chapter, I review the structure, effectiveness, and safety of modern trauma DC; recent studies suggesting variation in and potential harm related to the overuse of DC surgery between trauma centers; and published consensus indications for the use of DC surgery and DC interventions that aim to reduce this variation and guide future research.