Time is domain: factors affecting primary fascial closure after trauma and non-trauma damage control laparotomy (data from the EAST SLEEP-TIME multicenter registry).

Abstract

Damage control laparotomy (DCL) is used for both traumatic and non-traumatic indications. Failure to achieve primary fascial closure (PFC) in a timely fashion has been associated with complications including sepsis, fistula, and mortality. We sought to identify factors associated with time to PFC in a multicenter retrospective cohort. We reviewed retrospective data from 15 centers in the EAST SLEEP-TIME registry, including age, comorbidities (Charlson Comorbidity Index [CCI]),small and large bowel resection, bowel discontinuity, vascular procedures, retained packs, number of re-laparotomies, net fluid balance after 24h, trauma, and time to first takeback in 12-h increments to identify key factors associated with time to PFC. In total, 368 patients (71.2% trauma, of which 50.6% were penetrating, median ISS 25 [16, 34], with median Apache II score 15 [11, 22] in non-trauma) were in the cohort. Of these, 92.9% of patients achieved PFC at 60.8 ± 72.0h after 1.6 ± 1.2 re-laparotomies. Each additionalre-laparotomy reduced the odds of PFC by 91.5% (95%CI 88.2-93.9%, p < 0.001).Time to first re-laparotomy was highly significant (p < 0.001) in terms of odds of achieving PFC, with no difference between 12 and 24h to first re-laparotomy (ref),and decreases in odds of PFC of 78.4% (65.8-86.4%, p < 0.001) for first re-laparotomy after 24.1-36h, 90.8% (84.7-94.4%, p < 0.001) for 36.1-48h, and 98.1% (96.4-99.0%, p < 0.001) for > 48h. Trauma patients had increased likelihood of PFC in two separate analyses (p = 0.022 and 0.002). Time to re-laparotomy ≤ 24h and minimizing number of re-laparotomies are highly predictive of rapid achievement of PFC in patients after trauma- and non-trauma DCL. 2B.