Independent predictors of mortality following damage control surgery in an academic trauma centre: A retrospective cohort study

Abstract

Background Damage control surgery (DCS) is a life-saving strategy for critically injured patients in extremis . Identifying predictors of mortality in this population may help guide clinical decision making and resource allocation in low- and middle-income countries. This study aimed to identify independent predictors of in-hospital mortality following DCS. Methods We conducted a retrospective analysis of 219 consecutive patients who underwent DCS at a trauma centre, over 3 years, between June 2021 and June 2024. Patient demographics, physiological parameters, laboratory values, transfusion requirements, operative details and outcomes were compared between survivors and non-survivors. Multivariable logistic regression analysis was performed to identify independent predictors of mortality. Results The overall in-hospital mortality rate was 11.0% (n = 24). Patients were predominantly male (93.5%) with penetrating trauma (84.5%). Non-survivors demonstrated significantly lower Glasgow Coma Scale scores (13.0 vs. 15.0, p < 0.001), lower arterial pH (7.07 vs. 7.29, p < 0.001), higher lactate levels (13.4 vs. 6.3 mmol/L, p < 0.001) and greater transfusion requirements (p < 0.001). Multivariable analysis identified three independent predictors of mortality: elevated lactate (OR 4.33 per SD increase), lower Glasgow Coma Scale (OR 0.56 per SD increase) and lower arterial pH (OR 1.34 per SD decrease). The predictive model demonstrated excellent discrimination (AUC 0.912). Conclusions Lactate, Glasgow Coma Scale and arterial pH are independent predictors of mortality following DCS. These readily available clinical parameters may assist in prognostication and guide resuscitation efforts in this high-risk patient population.