Surgical Decision-Making in Damage Control Surgery: A System-Based Approach

The concepts of damage control surgery (DCS) have been part of our clinical armamentarium in trauma and emergency surgery for decades. In recent years, the DCS has expanded to other surgical disciplines: emergency neurosurgery, orthopedic, thoracic, vascular, and other surgical disciplines. The DCS is characterized by termination of the surgical intervention after control of bleeding and contamination, followed by definitive management. In other words, it is a staged approach that takes into consideration the physiological reserve of the patient, and it is designed to avoid the lethal diamond of hypothermia, acidosis, hypocalcemia, and coagulopathy. The decision-making process in DCS is complex and requires solid knowledge of physiological status of the patient as well the associated injuries or comorbid disease and predicts the worsening of patient’s condition. In this chapter we aim to update and highlight the current principles and practices of damage control surgery and the decision-making process into this life-saving maneuver.