Adeel A Shamim, MD1, Suhail Zeineddin, MD2, Ahmad Zeineddin, MD1, Enrique De La Cruz, MD1, Olubode Olufajo, MD1, Terrance Fullum, MD, MBA1, Edward Cornwell III, MD1, Daniel Tran, MD1. 1Howard University Hospital, 2Mayo Clinic, Rochester
BACKGROUND: Exploratory laparotomy (EL) has been widely regarded as the definitive diagnostic and therapeutic modality for abdominal trauma in the US. However, many centers have started using Diagnostic Laparoscopy (DL) in stable trauma patients in an effort to reduce the incidence of Non-therapeutic Laparotomy (NL). We aim to compare the outcomes of NL and DL in the trauma population in the US using a national database.
METHODS: Using ICD-9 codes, the National Trauma Data Bank (2010-2015) was queried for all patients undergoing any abdominal surgical intervention. Patients were divided into two groups: laparoscopic intervention (DL) and open intervention (EL). Patients in the EL group who did not have any specific gastrointestinal, vascular, or urological procedure were considered to have undergone NL. Patients with Abbreviated Injury Score (AIS) in the abdomen of higher than zero and AIS>3 in any other body region were excluded. Patient demographics, presenting physiology, injury characteristics, and outcomes were described. After excluding patients who were converted to open from the DL group, multivariate regression models were used to analyze its outcomes vs the NL group with respect to mortality, hospital length of stay, and complications (VTE, pneumonia, ARDS, cardiac arrest, SSI, sepsis).
RESULTS: A total of 5,561 patients underwent NL vs 1,843 who underwent DL. Compared to DL group, the NL group were older (mean age: 35 vs. 31, P<0.01), more likely to be hypotensive on admission (11.3% vs 4.5%, P<0.01), and had higher injury severities (mean Injury Severity Score 10.8 vs. 7.3, P<0.01). Rate of penetrating injury was 69.9% vs 80.7% for patients in NL vs DL. Mortality rate was found to be 3.1% vs. 0.5% (P<0.01), rate of complications 11.2% vs. 3.6% (P<0.01), and median length of stay 6 vs. 3 days (P<0.01) for NL and DL groups, respectively. On multivariate analysis, NL was associated with increased mortality (OR 2.4, 95% CI 1.1-5.4), higher rate of complications (OR 1.9, 95% CI 1.4-2.6) and a longer hospital stay (Coeff. 2.3, 95% CI 1.7-2.9).
CONCLUSION: The favorable outcome profile of DL compared to NL highlights the importance of utilizing this modality in the armamentarium of trauma surgeons in appropriate patients. These findings warrant further investigation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95571
Program Number: S144
Presentation Session: Acute Care
Presentation Type: Podium