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Decreasing the Use of Damage Control Laparotomy in Trauma: A Quality Improvement Project. | LitMetric

AI Article Synopsis

  • A quality improvement (QI) project aimed to reduce damage control laparotomy (DCL) rates, which were previously high at 30% in a trauma center.
  • From November 2013 to October 2015, the project led to a significant decrease in DCL rates from 39% to 23%, and this reduction was maintained throughout the study.
  • Despite fewer DCLs, there were no significant changes in complications or mortality rates, indicating that the quality of care improved without increased risks.

Article Abstract

Background: Our institution has published damage control laparotomy (DCL) rates of 30% and documented the substantial morbidity associated with the open abdomen. The purpose of this quality improvement (QI) project was to decrease the rate of DCL at a busy, Level I trauma center in the US.

Study Design: A prospective cohort of all emergent trauma laparotomies from November 2013 to October 2015 (QI group) was followed. The QI intervention was multifaceted and included audit and feedback for every DCL case. Morbidity and mortality of the QI patients were compared with those from a published control (control group: emergent laparotomy from January 2011 to October 2013).

Results: A significant decrease was observed immediately on beginning the QI project, from a 39% DCL rate in the control period to 23% in the QI group (p < 0.001). This decrease was sustained over the 2-year study period. There were no differences in demographics, Injury Severity Score, or transfusions between the groups. No differences organ/space infection (control 16% vs QI 12%; p = 0.15), fascial dehiscence (6% vs 8%; p = 0.20), unplanned relaparotomy (11% vs 10%; p = 0.58), or mortality (9% vs 10%; p = 0.69) were observed. The reduction in use resulted in a decrease of 68 DCLs over the 2-year period. There was a further reduction in the rate of DCL to 17% after completion of the QI project.

Conclusions: A QI initiative rapidly changed the use of DCL and improved quality of care by decreasing resource use without an increase morbidity or mortality. This decrease was sustained during the QI period and further improved upon after its completion.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5533621PMC
http://dx.doi.org/10.1016/j.jamcollsurg.2017.04.010DOI Listing

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