{Reference Type}: Journal Article
{Title}: Time is domain: factors affecting primary fascial closure after trauma and non-trauma damage control laparotomy (data from the EAST SLEEP-TIME multicenter registry).
{Author}: Kwon E;Krause C;Luo-Owen X;McArthur K;Cochran-Yu M;Swentek L;Burruss S;Turay D;Krasnoff C;Grigorian A;Nahmias J;Butt A;Gutierrez A;LaRiccia A;Kincaid M;Fiorentino M;Glass N;Toscano S;Ley EJ;Lombardo S;Guillamondegui O;Bardes JM;DeLa'O C;Wydo S;Leneweaver K;Duletzke N;Nunez J;Moradian S;Posluszny J;Naar L;Kaafarani H;Kemmer H;Lieser M;Hanson I;Chang G;Bilaniuk JW;Nemeth Z;Mukherjee K;
{Journal}: Eur J Trauma Emerg Surg
{Volume}: 0
{Issue}: 0
{Year}: Nov 2021 29
{Factor}: 2.374
{DOI}: 10.1007/s00068-021-01814-w
{Abstract}: <B>OBJECTIVE: </B>Damage control laparotomy (DCL) is used for both traumatic and non-traumatic indications. Failure to achieve primary fascial closure (PFC) in a timely fashion has been associated with complications including sepsis, fistula, and mortality. We sought to identify factors associated with time to PFC in a multicenter retrospective cohort.<BR><B>METHODS: </B>We reviewed retrospective data from 15 centers in the EAST SLEEP-TIME registry, including age, comorbidities (Charlson Comorbidity Index [CCI]), small and large bowel resection, bowel discontinuity, vascular procedures, retained packs, number of re-laparotomies, net fluid balance after 24 h, trauma, and time to first takeback in 12-h increments to identify key factors associated with time to PFC.<BR><B>RESULTS: </B>In total, 368 patients (71.2% trauma, of which 50.6% were penetrating, median ISS 25 [16, 34], with median Apache II score 15 [11, 22] in non-trauma) were in the cohort. Of these, 92.9% of patients achieved PFC at 60.8 ± 72.0 h after 1.6 ± 1.2 re-laparotomies. Each additional re-laparotomy reduced the odds of PFC by 91.5% (95%CI 88.2-93.9%, p < 0.001). Time to first re-laparotomy was highly significant (p < 0.001) in terms of odds of achieving PFC, with no difference between 12 and 24 h to first re-laparotomy (ref), and decreases in odds of PFC of 78.4% (65.8-86.4%, p < 0.001) for first re-laparotomy after 24.1-36 h, 90.8% (84.7-94.4%, p < 0.001) for 36.1-48 h, and 98.1% (96.4-99.0%, p < 0.001) for > 48 h. Trauma patients had increased likelihood of PFC in two separate analyses (p = 0.022 and 0.002).<BR><B>CONCLUSIONS: </B>Time to re-laparotomy ≤ 24 h and minimizing number of re-laparotomies are highly predictive of rapid achievement of PFC in patients after trauma- and non-trauma DCL.<BR><B>METHODS: </B>2B.