Damage Control Surgery in the Era of Globalization of Health Care - Military and International Outcomes: A SystematicReview

Introduction: Damage Control Surgery (DCS) is a surgical technique used to manage critically ill and injured patients. This study examines the most recent 10-y outcomes related to DCS, with the secondary goal of scrutinizing the outcomes after DCS across surgical theaters.

Methods: Studies published between 2012 and 2021 that described adult patients undergoing Abdominal DCS after traumatic injury were included. Outcomes were reported as medians-of-means and interquartile range.

Results: Fifty-two studies met inclusion criteria (9932 patients), all 52 were included in the Military versus Civilian comparison which includes 46 Civilian (9244 patients) and 6 Military (688 patients) studies. Forty-three studies were included in the United States (US) and non-US comparison, with 10 non-US (2092 patients), and 33 US (6572 patients) studies. Overall, study quality was low, the majority having a high or unclear risk of bias. Across all studies, the median 24-h mortality was 14% (5.1-21.2) and 30-d mortality was 17.9% (9.4-28.3). Between subgroups, the Military cohort had a 30-d mortality 9-fold lower than the Civilian cohort (2.1% versus 18.9%), and the non-US cohort had more than 3 times the 24-h mortality (23.8% versus 7.5%) and double the 30-d mortality (37.2% versus 14.6%) of the US cohort.

Conclusions: Striking disparities are seen within current literature as it relates to outcomes after DCS between Military and Civilian and US and non-US populations. Trauma surgeons both within the US and internationally may benefit from looking to their Military counterparts for guidance to better care patients requiring DCS.