Mortality in hypotensive combat casualties who require emergent laparotomy in the forward deployed environment

Introduction Damage control (DCR) principles were incorporated into the military's Joint Trauma System Clinical Practice Guidelines (CPG) in 2008. Despite broad acceptance of damage control in civilian trauma, mortality rates within hypotensive civilian patients requiring emergent laparotomy remain over 40%. We sought to examine combat casualties requiring emergent laparotomy to better understand how mortality rates compare to civilian trauma. Methods The DoD Trauma Registry (2004–2020) was queried for adult casualties who underwent emergent laparotomy in the combat theater. Patients who were hypotensive (SBP <90) on arrival were compared to normotensive patients. Mortality was the primary outcome of interest. Mortality rates before (2004–2007) and after (2009–2020) DCR CPG implementation were analyzed. Results 1051 patients were studied. Overall mortality was 6.5% for normotensive casualties and 28.7% for hypotensive casualties. Mortality decreased in normotensive patients but remained unchanged in hypotensive patients following the implementation of the DCR CPG. Conclusion Hypotensive combat casualties undergoing emergent laparotomy demonstrated improved survival when compared to historical civilian counterparts. Despite trauma management advances, mortality rates remain high in hypotensive patients requiring emergent laparotomy.