Quality Improvement of Damage Control Laparotomy: Impact of the Establishment of a Single Korean Regional Trauma Center
Damage control laparotomy (DCL) is a lifesaving technique to minimize the lethal triad of coagulopathy, hypothermia, and acidosis. The government has nominated and supported our center as one of the regional trauma centers of South Korea since 2014. This study aimed to investigate the improving outcomes of patients undergoing DCL before and after the establishment of the trauma center.
The period from January 2011 to December 2017 was divided into pre-trauma center (pre-TC) (2011–2013) and trauma center (TC) (2014–2017) periods. Multivariable logistic regression was performed to identify the risk factors and risk-adjusted cumulative sum (RA-CUSUM), and graphs were used to monitor the change in mortality.
Of the 485 patients who underwent trauma laparotomy, DCL was performed for 119 patients (24.5%). The operation time (99 vs. 80 min, p = 0.022), time from admission to operation (125 vs. 112 min, p = 0.010), time from admission to first treatment (119 vs. 99 min, p = 0.004), and time from admission to first transfusion (70 vs. 52 min, p = 0.009) were significantly shortened in the TC period. The ratio of plasma to packed red blood cells in massive transfusions (≥PRBCs 10 units within the first 24 h) was significantly increased in the TC period (0.56 vs. 0.72, p = 0.004). RA-CUSUM curves revealed that the risk-adjusted 30-day mortality improved and then plateaued in the TC period.
After the implementation of a trauma center, more prompt intervention and damage control resuscitation could be achieved. Moreover, risk-adjusted mortality of DCL was improved.
We would like to thank Chang Hyun Kim and In-Soo Shin for their useful advice on statistical analysis.
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interest.
- 5.Cirocchi R, Montedori A, Farinella E, Bonacini I, Tagliabue L, Abraha I (2013) Damage control surgery for abdominal trauma. Cochrane Database Syst Rev 3:Cd007438Google Scholar
- 20.Lewis SR, Pritchard MW, Evans DJ, Butler AR, Alderson P, Smith AF et al (2018) Colloids versus crystalloids for fluid resuscitation in critically ill people. Cochrane Database Syst Rev 8:Cd000567Google Scholar