A Multi-Institutional Analysis of Damage Control Laparotomy in Elderly Trauma Patients: Do Geriatric Trauma Protocols Matter?

Alison Smith, Alexandra Onyiego, Juan Duchesne, Danielle Tatum, Charles Harris, Oscar I. Moreno-Ponte, Aaron Strumwasser, Kenji Inaba, Terence O'Keeffe, Joshua Black, Megan T. Quintana, Shailvi Gupta, Jason Brocker, Martin Schreiber, Maryanne L. Pickett, Michael W. Cripps, Chrissy Guidry

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Trauma centers are receiving increasing numbers of older trauma patients. There is a lack of literature on the outcomes for elderly trauma patients who undergo damage control laparotomy (DCL). We hypothesized that trauma centers with geriatric protocols would have better outcomes in elderly patients after DCL. METHODS: A retrospective chart review of consecutive adult trauma patients with DCL at 8 level 1 trauma centers was conducted from 2012 to 2018. Patients aged 40 or older were included. Age ≥ 55 years was defined as elderly. Demographics, injury information, clinical outcomes, including mortality, and complications were recorded. Univariate and multivariate analyses were performed. RESULTS: A total of 379 patients with DCLs were identified with an average age of 54.8 ± 0.4 years with 39.3% (n = 149/379) of patients aged ≥ 55. Geriatric protocols or a consulting geriatric service was present at 37.5% (n = 3/8) of institutions. Age ≥ 55 was a significant risk factor for in-hospital mortality (OR 2, 95% CI 1.0-4.0, P = .04). Institutions without dedicated geriatric trauma protocols/services had higher overall in-hospital mortality on both univariate (57.9% vs 34.3%, P = .02) and multivariate analyses (OR 2.1, 95% CI 1.3-3.4, P < .001). CONCLUSIONS: Surgical management of older trauma patients remains a challenge. Geriatric protocols or dedicated services were found to be associated with improved outcomes. Future efforts should focus on standardizing the availability of these resources at trauma centers.

Original languageEnglish (US)
Pages (from-to)1135-1143
Number of pages9
JournalThe American surgeon
Volume86
Issue number9
DOIs
StatePublished - Sep 1 2020

Keywords

  • damage control
  • geriatrics
  • trauma

ASJC Scopus subject areas

  • Surgery

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