Damage Control Surgery may be a Safe Option for Severe Non-Trauma Peritonitis Management: Proposal of a New Decision-Making Algorithm

• Published in: World journal of surgery 2021-04, Vol.45 (4), p.1043-1052
• Main Authors: Ordoñez, Carlos A., Parra, Michael, García, Alberto, Rodríguez, Fernando, Caicedo, Yaset, Serna, José Julián, Salcedo, Alexander, Franco, Josefa, Toro, Luis Eduardo, Ordoñez, Juliana, Pino, Luis Fernando, Guzmán, Mónica, Orlas, Claudia, Herrera, Juan Pablo, Aristizábal, Gonzalo, Pata, Francesco, Di Saverio, Salomone
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Algorithms; Anastomosis; Cardiac Surgery; Complications; Damage; Decision making; Disease management; General Surgery; Laparotomy; Medicine; Medicine & Public Health; Mortality; Multivariate analysis; Original Scientific Report; Ostomy; Patients; Peritonitis; Statistical analysis; Surgery; Thoracic Surgery; Trauma; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-020-05854-y

Background Damage control surgery (DCS) has emerged as a new option in the management of non-traumatic peritonitis patients to increase survival in critically ill patients. The purpose of this study was to compare DCS with conventional strategy (anastomosis/ostomies in the index laparotomy) for severe non-traumatic peritonitis regarding postoperative complications, ostomy rate, and mortality and to propose a useful algorithm in the clinical practice. Methods Patients who underwent an urgent laparotomy for non-trauma peritonitis at a single level I trauma center in Colombia between January 2003 and December 2018, were retrospectively included. We compared patients who had DCS management versus definitive initial surgical management (DISM) group. We evaluated clinical outcomes and morbidities among groups. Results 290 patients were included; 81 patients were treated with DCS and 209 patients underwent DISM. Patients treated with DCS had a worse critical status before surgery with higher SOFA score [median, DCS group: 5 (IQR: 3–8) vs. DISM group: 3 (IQR: 1–6), p   6 points and APACHE-II > 20 points correlated with a higher probability of DCS. Conclusion DCS in severe non-trauma peritonitis patients is feasible and safe as surgical strategy management without increasing mortality, length hospital of stay, or complications. DCS principles might be applied in the non-trauma scenarios without increase the stoma rate.