BACKGROUNDAfter the successful implementation in trauma, damage-control surgery (DCS) is being increasingly used in patients with nontraumatic emergencies. However, the role of DCS in the nontrauma setting is not well defined. The aim of this study was to investigate the effect of DCS on mortality in patients with nontraumatic abdominal emergencies.METHODSSystematic literature search was done using PubMed. Original articles addressing nontrauma DCS were included. Two meta-analyses were performed, comparing (1) mortality in patients undergoing nontrauma DCS versus conventional surgery (CS) and (2) the observed versus expected mortality rate in the DCS group. Expected mortality was derived from Acute Physiology And Chronic Health Evaluation, Simplified Acute Physiology Score, and Portsmouth Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity scores.RESULTSA total of five nonrandomized prospective and 16 retrospective studies were included. Nontrauma DCS was performed in 1,238 and nontrauma 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 nontrauma DCS and CS group (risk difference, 0.09; 95% confidence interval, −0.06 to 0.24). Meta-analysis 2, including 14 studies, revealed a significantly lower observed than expected mortality rate in patients undergoing nontrauma DCS (risk difference, −0.18; 95% confidence interval, −0.29 to −0.06).CONCLUSIONThis meta-analysis revealed no significantly different mortality in patients undergoing nontrauma DCS versus 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 nontraumatic abdominal emergencies remains unclear. Further prospective investigation into this topic is warranted.LEVEL OF EVIDENCESystematic review and meta-analysis, level III.

Objective After the successful implementation in trauma patients, damage control surgery (DCS) is being increasingly used in non-traumatic abdominal emergencies, too. However, non-trauma DCS (NT-DCS) is currently a matter of debate and has not yet been comprehensively assessed. The aim of this meta-analysis was to investigate the effect of NT-DCS on mortality in patients with abdominal emergencies. Methods Systematic literature search using PubMed. Original articles addressing mortality in patients undergoing NT-DCS or non-trauma conventional surgery (NT-CS) for abdominal emergencies were included. Descriptive statistics and two meta-analyses were performed. Meta-analysis 1 compared mortality in patients undergoing NT-DCS vs. NT-CS. Meta-analysis 2 assessed the observed vs. expected mortality rate, based on APACHE, POSSUM and SAPS scores, in the NT-DCS group. Continuous and categorical variables were reported as weighted means and proportions. Effect sizes were described as risk differences (RD) with 95% confidence intervals (CI). Results Literature search revealed 1314 articles. Of these, 21 studies published 2004-2019 were included. NT-DCS was performed in 1238 and NT-CS in 936 patients. In the NT-DCS vs. NT-CS group mean age was 61.0 vs. 64.9 years and the proportion of male patients 58.6% vs. 52.9%, respectively. Most frequent indications for NT-DCS were hollow viscus perforation (28.4%), mesenteric ischemia (26.5%), anastomotic leak (19.6%), haemorrhage (18.4%), abdominal compartment syndrome (17.4%), bowel obstruction (15.5%), and pancreatitis (13.1%). In meta-analysis 1, mortality was not significantly different in the NT-DCS vs. NT-CS group (RD 0.09, 95% CI -0.06/0.24). Meta-analysis 2 revealed a significantly lower observed than the expected mortality rate in patients undergoing NT-DCS (RD -0.18, 95 % CI -0.29/-0.06). Heterogeneity of included studies was high in both meta-analyses (I2=89.0% and 79.9%, respectively). Conclusion This meta-analysis revealed no significantly different mortality in patients with abdominal emergencies undergoing NT-DCS vs. NT-CS. However, observed mortality was significantly lower than the expected mortality rate in the NT-DCS group, suggesting a benefit of the DCS approach. Based on these results, the effect of DCS in patients with non-traumatic abdominal emergencies remains unclear. Further prospective investigation into this topic is warranted.

No abstract