Dehiscence After Damage Control Laparotomy for Trauma: Who Is Really at Risk?

INTRODUCTION: Few data are available regarding fascial dehiscence after damage control laparotomy (DCL). We aimed to identify the incidence and risk factors of fascial dehiscence following DCL in the trauma population. METHODS: This is a retrospective cross-sectional study from an urban academic Level I trauma institute. Adult patients, ≥14 years of age, who underwent DCL for traumatic injuries between July 1, 2017 and June 30, 2022 were included. Dehiscence was analyzed using logistic regression models to report odds ratios. RESULTS: A total of 251 patients met inclusion criteria. The rate of fascial dehiscence was 12.4%. Fascial dehiscence was associated with a higher positive fluid balance at time of abdominal closure (+6496 mL [interquartile range (IQR): 3923, 8853 mL] versus +3583 mL [IQR: 1209, 7877 mL]; P = 0.012), increased number of abdominal operations (3 [IQR 2, 4] versus 2 [IQR 2, 3]; P < 0.001), and presence of enteric injury (80.6% versus 50.4%; P = 0.008). In a multivariable analysis, presence of enteric injury was independently associated with 3.7-fold higher odds of fascial dehiscence. CONCLUSIONS: Presence of enteric injury was independently associated with increased incidence of abdominal fascial dehiscence in patients who underwent DCL for trauma. Additionally, positive fluid status at time of abdominal closure and total number of trips to the operating room prior to abdominal closure may be important factors to consider when closing an open abdomen after DCL. Although prior studies have reported on the incidence of dehiscence following DCL, this study adds to the limited data available on specific factors contributing to an increased risk of fascial dehiscence that might inform surgical decision making.