Cirurgia de controle de danos: Estamos perdendo controle das indicações?

Abstract

Objective: to analyze the surgeons’ subjective indications for damage control surgery, correlating with objective data about the patients’ physiological state at the time the surgery was chosen. Methods: we carried out a prospective study between January 2016 and February 2017, with 46 trauma victims who were submitted to damage control surgery. After each surgery, we applied a questionnaire to the attending surgeon, addressing the motivations for choosing the procedure. We collected data in the medical records to assess hemodynamic conditions, systolic blood pressure and heart rate on arrival at the emergency room (grade III or IV shock on arrival at the emergency room would partially justify the choice). We considered elevation of serum lactate level, prolonged prothrombin time and blood pH below 7.2 as laboratory indicators of worse prognosis, objectively corroborating the subjective choice of the procedure. Results: the main indications for damage control surgery were hemodynamic instability (47.8%) and high complexity lesions (30.4%). Hemodynamic and laboratory changes corroborated the choice in 65.2% of patients, regardless of the time; 23.9% presented hemodynamic changes compatible with degree III and IV shock, but without laboratory alterations; 4.3% had only laboratory abnormalities and 6.5% had no alterations at all. Conclusion: in the majority of cases, there was early indication for damage control surgery, based mainly on hemodynamic status and severity of lesions, and in 65.2%, the decision was compatible with alterations in objective hemodynamic and laboratory data.