Damage Control Surgery in Patients with Non-traumatic Abdominal Emergencies: A Systematic Review and Meta-Analysis.

Haltmeier, Tobias; Falke, Monika; Quaile, Oliver; Candinas, Daniel; Schnüriger, Beat (2022). Damage Control Surgery in Patients with Non-traumatic Abdominal Emergencies: A Systematic Review and Meta-Analysis. The journal of trauma and acute care surgery, 92(6), pp. 1075-1085. Wolters Kluwer 10.1097/TA.0000000000003488

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BACKGROUND

After the successful implementation in trauma, damage control surgery (DCS) is being increasingly used in patients with non-traumatic emergencies. However, the role of DCS in the non-trauma setting is not well defined. The aim of this study was to investigate the effect of DCS on mortality in patients with non-traumatic abdominal emergencies.

METHODS

Systematic literature search using PubMed. Original articles addressing non-trauma DCS were included. Two meta-analyses were performed, comparing (#1) mortality in patients undergoing non-trauma DCS vs. conventional surgery (CS) and (#2) the observed vs. expected mortality rate in the DCS group. Expected mortality was derived from APACHE, SAPS, and P-POSSUM scores.

RESULTS

A total of five non-randomized prospective and 16 retrospective studies were included. NontraumaDCS was performed in 1,238 and non-trauma CS in 936 patients. Frequent indications for surgery in the DCS group were (weighted proportions) hollow viscus perforation (28.5%), mesenteric ischemia (26.5%), anastomotic leak and postoperative peritonitis (19.6%), nontraumatic hemorrhage (18.4%), abdominal compartment syndrome (17.8%), bowel obstruction (15.5%), and pancreatitis (12.9%). In meta-analysis #1, including eight studies, mortality was not significantly different between the non-trauma DCS and CS group (risk difference [RD] 0.09, 95% CI -0.06/0.24). Meta-analysis #2, including 14 studies, revealed a significantly lower observed than expected mortality rate in patients undergoing non-trauma DCS (RD -0.18, 95% CI -0.29/-0.06).

CONCLUSION

This meta-analysis revealed no significantly different mortality in patients undergoing nontrauma DCS vs. CS. However, observed mortality was significantly lower than the expected mortality rate in the DCS group, suggesting a benefit of the DCS approach. Based on these two findings, the effect of DCS on mortality in patients with non-traumatic abdominal emergencies remains unclear. Further prospective investigation into this topic is warranted.

LEVEL OF EVIDENCE

III, systematic review and meta-analysis.

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