Trauma Laparotomy: A Surgical Odyssey

A retrospective analysis of 203 trauma patients undergoing laparotomy over an 18-year period by a single surgeon at a level 1 trauma center was performed.These were young (mean age=33.84+/-14.74)seriously injured (mean ISS=22.32+/-11.61)patients who sustained a mix of blunt (52%) and penetrating injury (48%).Many of these patients were in shock at the time of admission (mean base deficit 7.30+/-5.06).Patients requiring a massive transfusion protocol (MTP) were stratified.Those with a single laparotomy and MTP had more balanced resuscitation when compared to those with MTP and damage control.The overall mortality was 5.4%.A damage control laparotomy was performed in 34 patients with a mortality of 23.5%(8 patients).4 patients received ultra-massive transfusion (more than 20 units of Packed red cells) during their initial operation.3 of these patient survived.A stepwise regression analysis yielded GCS (Glasgow Coma Score) as the sole predictor of outcome.Individual trauma surgeons can continue the search for better outcomes by reviewing their overall care.