S. Bhogadi1, A. Nelson1, K. El-Qawaqzeh1, C. Stewart1, H. Hosseinpour1, M. Ditillo1, L. J. Magnotti1, T. Anand1, A. Tang1, B. Joseph1 1University Of Arizona, Division Of Trauma, Surgical Critical Care, Burns And Acute Care Surgery, Department Of Surgery, College Of Medicine, Tucson, AZ, USA
Introduction: Evidence has demonstrated safety of selective nonoperative management, as well as high rates of negative findings in trauma patients undergoing exploratory laparotomy when not selected properly. The aim of our study is to compare outcomes of trauma patients who underwent negative laparotomies versus those managed non-operatively.
Methods: We performed a two-year (2017-2018) retrospective cohort analysis of the ACS-TQIP database. We included all adult (≥18 yrs) severe abdominal trauma patients (Abdomen-AIS>3) who received early blood product transfusions (≤4 hours). Patients who were transferred, dead on arrival, or had severe head or thoracic injuries (Head or Chest-AIS >3) were excluded. Patients were stratified into those who received non-operative management and those who underwent a negative laparotomy. Outcome measures were in-hospital mortality, major in-hospital complications, and survivor-only hospital and ICU length of stay. Multivariable logistic regression was performed to identify independent predictors of negative laparotomy, adjusting for patient demographics, injury parameters and mechanism, admission vitals, GCS, and ACS trauma center verification level.
Results: A total of 8,081 severe abdominal trauma patients were identified, of which 4,469 (55%) had a positive laparotomy, 1,410 (17%) underwent negative laparotomy, and 2,202 (27%) underwent nonoperative management. Among the negative laparotomy and nonoperative management patients, mean age was 43+19 years, 72% patients were male, 63% patients sustained blunt injury, and the median ISS was 17 [11-24]. Overall mortality was 18% and major complication rate was 22%. On univariate analysis, negative laparotomy group had higher rates of in-hospital mortality, major complications, and adverse discharge disposition, when compared to patients managed nonoperatively (Table). On multivariate logistic regression analysis, age ≥65 years, sustaining penetrating injury, and management at an ACS Level II trauma center were independently associated with higher odds of undergoing a negative laparotomy (Table).
Conclusion: Our results suggest that one in six severe abdominal injury patients may be undergoing negative laparotomy, with these patients having higher risk of mortality and major in-hospital complications when compared to nonoperative approached patients. Older penetrating trauma patients who are managed at lower level trauma centers are at higher risk of undergoing a negative laparotomy, and special attention should be paid to them to improve outcomes and healthcare resource utilization.
