Analysis of time to care and cost of damage control laparotomies in a tertiary centre in South Africa

Abstract

Background: Damage control laparotomy (DCL) is a life-saving strategy for the management of hemodynamically unstable abdominal injuries. Although the indications are well established, factors specific to local trauma ecosystems lead to delayed implementation of DCL.

Methods: A retrospective review of prospectively collected data identified all patients who underwent DCL for trauma indications at Tygerberg Hospital between 1 January 2016 and 31 December 2020. Data were analysed using Python [version 3.10]. A hybrid costing model was used to determine the cost of DCL.

Results: One hundred and thirty-one (131) patients were included, of which 96.9% were male and the mean age was 33.4 years. Gunshots were the most common mechanism of injury (77.9%), followed by vehicle collisions (9.9%) and stabs (7.9%). The in-hospital mortality was 41.5%. The median time from incident to arrival at the trauma centre was 3 hours 7 minutes (187 minutes) and patients waited a median of 6 hours (360 minutes) for surgery once in hospital. The median duration of surgery was 120 minutes and the median time to relook laparotomy was 59 hours. The median ICU and ward stay was 9.7 days and 25.7 days, respectively. Cost was calculated using a hybrid costing model, with the cost of care for survivors estimated at R 464 951 (USD $25 200) and for non-survivors R 307 827 (USD $16 684). Total cost of care for this cohort was R 42 160 625 (USD $2 285 129).

Conclusion: Delay in surgical care for DCL patients is worse for patients treated in our unit compared to those in other units, with associated cost placing significant economic burden on the healthcare sector.