Source | Treatment or exposure group (n) | Comparison group (n) | Confounding factors adjusted for | Outcome(s) |
---|---|---|---|---|
Harvin et al. 2016 [38] | DC laparotomy (n = 144) for intra-abdominal packing (68%), a second-look laparotomy (6%), hemodynamic instability (15%), to expedite postoperative care or intervention (8%), abdominal compartment syndrome prophylaxis (1%), contamination (1%), or for other/unclear reasons (1%) | Definitive laparotomy (n = 78) | Propensity scores created using 17 different variablesa | The adjusted incidence of ileus was 13% (95% CI, 6–26%) higher in the DC versus definitive laparotomy group The adjusted incidence of suture line failure was 7% (95% CI, 0–14%) higher in the DC versus definitive laparotomy group The adjusted incidence of GI bleed was 4% (95% CI, 0–7%) higher in the DC versus definitive laparotomy group The adjusted incidence of abdominal fascial dehiscence was 11% (95% CI, 2–19%) higher in the DC versus definitive laparotomy group The adjusted incidence of superficial SSI was 19% (95% CI, 10–28%) higher in the DC versus definitive laparotomy group The adjusted incidence of death was 18% (95% CI, 11–26%) higher in the DC versus definitive laparotomy group |
Ordoñez et al. 2014 [40] | DC laparotomy with primary duodenal repair (n = 14) for complex penetrating AAST grade II–IV duodenal injuries | Definitive laparotomy with primary duodenal repair for complex penetrating AAST grade II-IV duodenal injuries (n = 7) | None | Survival was 92.9% in the DC versus 100% in the definitive laparotomy group (p > 0.99) |
Thompson et al. 2013 [42] | DC surgery with or without the first stage of a Whipple procedure for patients with severe pancreaticoduodenal trauma (n = 12) | A complete Whipple procedure (including reconstruction) at the index operation for patients with severe pancreaticoduodenal trauma (n = 3) | None for all comparisons | Survival was 83.3% in the DC versus 100% in the complete Whipple group (p > 0.99) Sepsis occurred in 16.7% of the DC versus 100% of the complete Whipple group (p = 0.01) Enterocutaneous/enteroatmospheric fistulae occurred in 8.3% of the DC versus 66.7% of the complete Whipple group (p = 0.04) |
Rice et al. 2012 [43] | Those who had moderate or major deviations from a protocol that suggested use of DC surgery when any of the following were present: temperature < 35 °C, lactate > 4 mmol/L (or more than twice the ULN), or corrected pH < 7.3 (n = 92)a | Those who had no or minor deviations from the DC surgery protocol (n = 358)b | 13 variablesc | Survival at 90 d: adjusted OR, 0.50 (95% CI, 0.27–0.92) |
Martin et al. 2012 [14] | DC laparotomy for patients with an arrival systolic BP > 90 mmHg, no severe TBI (head AIS score < 3), and no combined abdominal injuries (n = 62) | Therapeutic definitive laparotomy in patients with an abdomen AIS score > 2 | 10 variablesd | Major postoperative complication: adjusted OR, 2.96 (95% CI, 1.25–6.99) The adjusted length of hospital stay was 9.69 d longer in patients who underwent DC instead of definitive laparotomy (p < 0.001) |
Chinnery et al. 2012 [44] | DC surgery for unstable patients with pancreatic and major associated organ and visceral vascular injuries (n = 43) | Before use of DC surgery for patients with this indication (n = 32) | None for both comparisons | Survival: OR, 0.082 (95% CI, 0.014–0.34) Postoperative complications (systemic, pancreatic, and intra-abdominal): OR, 8.02 (95% CI, 1.44–80.24) |
Mayberry et al. 2011 [45] | DC laparotomy for patients with full-thickness duodenal lacerations (n = 25) | Definitive surgery for patients with this indication (n = 16) | None | Duodenal-related complications: OR, 0.38 (95% CI, 0.029-3.83) |
Liu et al. 2011 [24] | DC laparotomy for patients with a preoperative temperature < 35 °C, PT > 16 s, PTT > 50 s, or pH < 7.3 or who received > 10 U PRBCs (n = 46) | Definitive laparotomy for patients with these indications (n = 58) | None for both comparisons | Survival: OR, 3.51 (95% CI, 1.18–11.73) Complications (pneumonia, peritonitis, intra-abdominal abscess, biliary or pancreatic fistula, bowel obstruction): OR, 0.29 (95% CI, 0.12–0.69) |
Yu et al. 2009 [25] | DC surgery for patients with the following: preoperative temperature < 35 °C, pH < 7.25, PT > 16 s, aPTT > 50 s, or systolic BP < 70 mmHg; transfusion >10 U PRBCs; inability to close the abdomen because of visceral edema; or a predicted surgical duration > 90 min (n = 45) | Definitive surgery for patients with these indications (n = 45) | None for all comparisons | Survival: OR, 3.03 (95% CI, 0.66–18.79) Complications (abscesses, ARDS, multiple organ failure): OR, 0.29 (95% CI, 0.099–0.80) Mean ICU LOS: 10 vs. 8 d (p = 0.02) Mean hospital LOS: 27 vs. 21 d (p = 0.01) |
MacKenzie et al. 2004 [51] | Laparotomy with early therapeutic perihepatic packing followed by angioembolization for patients with AAST grade IV-V liver injuries (n = 7)e | Definitive laparotomy for patients with AAST grade IV–V liver injuries (n = 30)e | None for all comparisons | Survival was 100% in the early packing versus 63.3% in the definitive laparotomy group (p = 0.08) Complications in the early packing vs. definitive laparotomy group included liver necrosis (OR, 4.88; 95% CI, 0.49–41.81), sepsis (OR, 1.75; 95% CI, 0.21–12.67), abscesses (OR, 6.75; 95% CI, 0.62–66.67), and bile leak (OR, 4.38; 95% CI, 0.56–35.95) Median hospital LOS: 30 vs. 10.5 d (p value NR) Median ICU LOS: 7 vs. 2 d (p value NR) |
Asensio et al. 2004 [52] | After implementation of a guideline that suggested use of DC surgery for patients with the following: transfusion > 4 L PRBCs or > 5 L PRBCs and whole blood combined; total OR fluid (PRBCs and whole blood, other blood products, and crystalloid) replacement > 12 L; operating room patient temperature ≤ 34 °C, serum [HCO3-] ≤ 15 mEq/L, or arterial pH ≤ 7.2; a thoracic or abdominal vascular injury or complex hepatic injury requiring packing; those requiring ED or operating room thoracotomy; or patients that develop intraoperative coagulopathy or dysrhythmias (n = 53) | Before implementation of the DC surgery guideline (n = 86) | None for all comparisons | Survival: OR, 0.99 (95% CI, 0.42 to 2.42) Intra-abdominal abscesses: OR, 0.29 (95% CI, 0.067 to 0.95) Abdominal fistula(e): 0.34 (95% CI, 0.059 to 1.32) Extra-abdominal infection: OR, 0.34 (95% CI, 0.15 to 0.77) Abdominal wall closure: OR, 44.93 (95% CI, 11.17 to 248.12) Mean SICU LOS: 14.1 vs. 22.4 d (p = 0.02) Mean hospital LOS: 22.9 vs. 36.8 d (p = 0.08) |
Apartsin et al. 2002 [23] | DC laparotomy for liver and retroperitoneal injuries (n = 62) or major small bowel injuries (n = 15) | Definitive laparotomy for liver and retroperitoneal (n = 59) and major small bowel injuries (n = 14) | None for both comparisons | Survival for liver and retroperitoneal injuries: OR, 2.73 (95% CI, 1.15 to 6.60) Survival for patients with major small bowel injuries: OR, 10.08 (95% CI, 1.44 to 80.87) |
Carrillo et al. 1998 [58] | DC laparotomy for patients with penetrating injuries to the iliac vessels (n = 14) (11 had combined arteriovenous injuries to the common and external iliac vessels) | Definitive laparotomy for patients with this indication (n = 50) (13 had combined arteriovenous injuries) | None for both comparisons | Survival overall: OR, 0.71 (95% CI, 0.16–3.70) Survival for patients with combined injuries: OR, 6.25 (95% CI, 0.50–324.50) |
Rotondo et al. 1993 [62] | DC laparotomy for penetrating trauma patients requiring transfusion of > 10 U PRBCs before completion or termination of laparotomy with ≥ 1 major abdominal vascular injury and ≥ 2 abdominal visceral injuries (n = 13) | Definitive laparotomy for penetrating trauma patients with this indication (n = 9) | None | Survival: OR, 26.67 (95% CI, 1.84–1296.95) |
Carmona et al. 1984 [67] | Therapeutic liver packing for patients with intraoperative hemodynamic instability after more conventional techniques of hemorrhage control (e.g., direct, Pringle maneuver, hepatic artery ligation) had failed (n = 17) | Definitive surgery for patients with this indication who were similarly matched on age, mechanism of injury, and associated injuries (n = 14) | None for both comparisons | Survival: OR, 2.05 (95% CI, 0.19–27.79) Infection: OR, 0.75 (95% CI, 0.13–4.43) |
Stone et al. 1983 [68] | DC laparotomy followed by closure of the abdomen under tension for patients who develop coagulopathy during operation (n = 17) | Definitive laparotomy for patients who develop coagulopathy during operation (n = 14) | None for all comparisons | Survival: OR, 23.83 (95% CI, 2.22–1102.13) All survivors (including n = 12 managed with DC and closure of the abdomen under tension and n = 1 managed with definitive laparotomy) developed complications, including wound infections (100% of those managed with DC), intra-abdominal abscesses (69.2% of the 13), and intestinal fistulae (15.4% of the 13) |