Faculty, Staff and Student Publications

Language

English

Publication Date

2-1-2026

Journal

Surgical Infections Journal

DOI

10.1177/10962964261419732

PMID

41622668

PMCID

PMC13035280

PubMedCentral® Posted Date

3-31-2026

PubMedCentral® Full Text Version

Author MSS

Abstract

Background: Damage control laparotomy (DCL) rates have declined and remained low. Given DCL's association with surgical site infections (SSIs), we hypothesize that SSI rates and severity, as per Clavien-Dindo (CD) classification, have decreased concurrently.

Patients and methods: A retrospective study was performed on patients (≥16 y) who underwent trauma laparotomy from January 2011 to December 2020. Patients who survived ≤48 hours were excluded. Data were divided into period 1 (January 2011-December 2015, DCL rates declined) and period 2 (January 2016-December 2020, low DCL rates were sustained). SSIs were defined as per the Centers for Disease Control and Prevention, and severity was graded by the CD scale (I-V). SSIs were classified as minor (CD grade I-II) and major (CD grade III-V). Uni-variable and multi-variable analyses were performed (p < 0.05).

Results: In total 1,975 patients met the inclusion criteria. Between periods 1 and 2, there was an increase in injury severity score (ISS); (19 [IQR: 10, 29] vs. 21 [IQR: 12, 34], p ≤ 0.001) and penetrating injuries (426 [44%] vs. 513 [51%], p = 0.002), with a decrease in DCL (283 [29%] vs. 153 [15%], p ≤ 0.001). A total of 355 (18%) patients developed an SSI, 18.5% (179) in period 1 and 17.5% (176) in period 2 (p = 0.5). On multi-variable analysis, after controlling for mechanism of injury, emergency room systolic blood pressure, wound classification, large bowel resection, ISS, splenectomy, and operating-room time at index laparotomy, DCL was associated with major SSIs.

Conclusions: Despite decreases in DCL, SSI rates and severity after trauma laparotomy remain stable, potentially because of increased injury severity and penetrating trauma. Identification of other potential modifiable risk factors is needed to decrease SSI incidence and severity.

Keywords

Damage control laparotomy, Surgical site infections, Laparotomy, Clavien-Dindo classification

Published Open-Access

yes

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