Protocol for Bedside Laparotomy in Trauma and Emergency General Surgery: A Low Return to the Operating Room
| Autor: | Jose J. Diaz, John A. Morris, Richard S. Miller, Ty Subhawong, Vicente Mejia, Andrea Proctor Subhawong, Patrick J. O'Neill |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Operating Rooms medicine.medical_specialty Abdominal compartment syndrome Decompression Point-of-Care Systems medicine.medical_treatment Perforation (oil well) Abdominal Injuries Clinical Protocols Laparotomy medicine Humans Decompensation Abscess Emergency Treatment Retrospective Studies business.industry Mortality rate General Medicine medicine.disease Surgery medicine.anatomical_structure Anesthesia Abdomen Female business |
| Zdroj: | The American Surgeon. 71:986-991 |
| ISSN: | 1555-9823 0003-1348 |
| Popis: | Bedside laparotomy (BSL) was introduced as a heroic procedure in trauma patients too unstable for safe transport to the operating room (OR). We hypothesize a BSL protocol would maintain patient safety while reducing OR use. Patients were prospectively entered into a BSL protocol from July 2002 to June 2003 and retrospectively reviewed. Protocol indications for BSL were abdominal compartment syndrome, decompensation due to hemorrhage, washout/closure, and sepsis in a patient too unstable for safe transport to the OR. Primary outcomes were mortality, emergent return to OR, and primary fascial closure (PFC). Trauma operating room charges and OR time were analyzed. One hundred thirty-three BSL were performed on 60 patients with an overall mortality of 23.3 per cent (14/60). There was an average of 2.2 BSL per patient (range 1–8). Indications for BSL were 1) explore/washout (n = 100, 75.2%), 2) decompression (n = 14, 10.5%), 3) infection/abscess (n = 12, 9.0%), 4) hemorrhage (n = 7, 5.3%). Five of 133 BSL (5.8%) were emergently returned to the OR because of perforation or compromised bowel. Trauma OR charges were $5,300 per cases with 2.12 hours per cases. The protocol standardized the conduct of BSL procedure to allow for a low return to OR rate of 5.8 per cent and had an overall in-hospital mortality rate of 23.3 per cent. Primary fascial closure of the abdomen had a significantly reduced hospital stay. BSL allowed trauma OR charges of $5,300 per cases with 2.12 hours per cases savings. |
| Databáze: | OpenAIRE |
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