What is the point of damage control surgery?

[Keno]

Hello all,

Just came off the DSTC course where damage control strategy was discussed in depth. I dont understand the fundamental rationale as it seems to me that everything that can be done in ICU (monitoring, warming, inotropes) can be done in theatre. So why do an abbreviated operation to rush the patient out of theatre?

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[45408]

everything that can be done in ICU (monitoring, warming, inotropes) can be done in theatre.

Not really. If you're continuing to operate, your patient will continue to lose blood, heat, and incur ongoing tissue damage with its associated cytokine release. Furthermore, the patient is under general anesthesia, a powerful vasodilator/cardiovascular depressant, so they're often requiring a lot more inotropes/pressors than they will when they're in the ICU not under general anesthesia. Weaning off pressors is a good thing.

Secondly, these things take a long time (6-12 hours). It would be absurd to stand there and watch the patient for that entire time in the OR if you're not operating. You can't do anything else while you're bumming around in the OR watching the patient's temperature rise. The OR is much more expensive to use (it's $60/minute, from what I've been quoted, which is about 20x more than the ICU).

So why do an abbreviated operation to rush the patient out of theatre?

Because the patient is going to become colder, more coagulopathic, more acidemic, and you're going to get further and further behind. The more blood product you give, the farther from a physiologic state you get. Stop the bleeding, stop enteral leakage, make sure vital organs/limbs are being perfused, and get out.

You might have other trauma patients to attend to as well, and a 6 hour definitive operation would leave them unattended. The trauma surgeon may want a subspecialist to help with a complicated reconstruction as well, and you don't need to call them in at 3am.

 

[Dwindlin]

(it's $60/minute, from what I've been quoted, which is about 20x more than the ICU).

That sounds like a bargain, I'm at a community place and supposedly it is around $150 a minute. This is for non-trauma/acute care surgeries.

 

[SLUser11]

That sounds like a bargain, I'm at a community place and supposedly it is around $150 a minute. This is for non-trauma/acute care surgeries.

My old hospital was "$60/minute" but I always thought the math was a little flawed. That assumes that all ORs and all OR staff are being constantly productive and all resources are being utilized. If it takes me 20 minutes to do a case instead of 10, I don't think the hospital just lost $600.

If you want to test it, just flip it around on the OR administrators and mention how much time you save by using certain expensive instruments.

 

[Dwindlin]

My old hospital was "$60/minute" but I always thought the math was a little flawed. That assumes that all ORs and all OR staff are being constantly productive and all resources are being utilized. If it takes me 20 minutes to do a case instead of 10, I don't think the hospital just lost $600.

If you want to test it, just flip it around on the OR administrators and mention how much time you save by using certain expensive instruments.

Sorry, I thought he was saying that's what the OR costs, as in what it is costing the patient to be in there. That's what I was talking about. When I was on surgery, at the end of a case my senior would hand me the needle driver and pickups and say "OK, you have $500 worth of time, go."