Early abdominal closure improves long-term outcomes after damage-control laparotomy.

BACKGROUND: The impact of initial clinical decisions on the long-term quality of life and functional outcome of patients who undergo damage-control laparotomy (DCL) is unknown. We hypothesized that early abdominal closure after DCL improves long-term outcomes.

METHODS: Patients (2005-2011) who underwent DCL (n = 140) at our Level I trauma center were identified. A total of 108 patients survived their hospitalization, and 15 died following discharge. Of the remaining 93 survivors, 59 were unreachable and not present in the social security death index. Our final study population of 34 survivors prospectively completed a standardized study questionnaire, the SF-36 health survey, and inpatient and outpatient records were reviewed. Survivors were compared on the basis of time with final abdominal closure (early, <7 days vs. late, >7 days; either primary closure or Vicryl mesh), and study variables were analyzed. A p < 0.05 was considered significant.

RESULTS: Our study population was primarily male (82%) of varying age (36 [13]) and mechanism (blunt 56%, penetrating 44%) with severe injuries (mean [SD] Injury Severity Score [ISS], 17 [8]). Despite no differences in age, sex, mechanism, ISS, admission Glasgow Coma Scale (GCS) score, or admission systolic blood pressure, early-closure patients (n = 13) had shorter hospital (25 days vs. 57 days) and intensive care unit (12 days vs. 20 days) stays and, upon long-term follow-up, higher physical (54 vs. 18), emotional (86 vs. 44), and general health (66 vs. 50) SF-36 scores than late-closure patients (n = 21) (all p < 0.05). Early-closure patients had less daily pain (38% vs. 95%), had higher overall SF-36 scores (66 vs. 46), and were more likely to return to work (54% vs. 10%) than late-closure patients (all p < 0.05).

CONCLUSION: Early clinical decisions impact the lives of critically injured patients. Abdominal closure within 7 days of DCL improves long-term quality of life and functional outcome.

LEVEL OF EVIDENCE: Therapeutic study, level IV.