Time is domain: factors affecting primary fascial closure after trauma and non-trauma damage control laparotomy (data from the EAST SLEEP-TIME multicenter registry)

Eugenia Kwon, Cassandra Krause, Xian Luo-Owen, Kaitlin McArthur, Meghan Cochran-Yu, Lourdes Swentek, Sigrid Burruss, David Turay, Chloe Krasnoff, Areg Grigorian, Jeffrey Nahmias, Ahsan Butt, Adam Gutierrez, Aimee LaRiccia, Michelle Kincaid, Michele Fiorentino, Nina Glass, Samantha Toscano, Eric Jude Ley, Sarah LombardoOscar Guillamondegui, James Migliaccio Bardes, Connie DeLa’O, Salina Wydo, Kyle Leneweaver, Nicholas Duletzke, Jade Nunez, Simon Moradian, Joseph Posluszny, Leon Naar, Haytham Kaafarani, Heidi Kemmer, Mark Lieser, Isaac Hanson, Grace Chang, Jaroslaw W. Bilaniuk, Zoltan Nemeth, Kaushik Mukherjee*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: Damage control laparotomy (DCL) is used for both traumatic and non-traumatic indications. Failure to achieve primary fascial closure (PFC) in a timely fashion has been associated with complications including sepsis, fistula, and mortality. We sought to identify factors associated with time to PFC in a multicenter retrospective cohort. Methods: We reviewed retrospective data from 15 centers in the EAST SLEEP-TIME registry, including age, comorbidities (Charlson Comorbidity Index [CCI]), small and large bowel resection, bowel discontinuity, vascular procedures, retained packs, number of re-laparotomies, net fluid balance after 24 h, trauma, and time to first takeback in 12-h increments to identify key factors associated with time to PFC. Results: In total, 368 patients (71.2% trauma, of which 50.6% were penetrating, median ISS 25 [16, 34], with median Apache II score 15 [11, 22] in non-trauma) were in the cohort. Of these, 92.9% of patients achieved PFC at 60.8 ± 72.0 h after 1.6 ± 1.2 re-laparotomies. Each additional re-laparotomy reduced the odds of PFC by 91.5% (95%CI 88.2–93.9%, p < 0.001). Time to first re-laparotomy was highly significant (p < 0.001) in terms of odds of achieving PFC, with no difference between 12 and 24 h to first re-laparotomy (ref), and decreases in odds of PFC of 78.4% (65.8–86.4%, p < 0.001) for first re-laparotomy after 24.1–36 h, 90.8% (84.7–94.4%, p < 0.001) for 36.1–48 h, and 98.1% (96.4–99.0%, p < 0.001) for > 48 h. Trauma patients had increased likelihood of PFC in two separate analyses (p = 0.022 and 0.002). Conclusion: Time to re-laparotomy ≤ 24 h and minimizing number of re-laparotomies are highly predictive of rapid achievement of PFC in patients after trauma- and non-trauma DCL. Level of evidence: 2B.

Original languageEnglish (US)
Pages (from-to)2107-2116
Number of pages10
JournalEuropean Journal of Trauma and Emergency Surgery
Issue number3
StatePublished - Jun 2022


  • Damage control laparotomy
  • Non-trauma
  • Primary fascial closure
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Critical Care and Intensive Care Medicine


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