Outcomes Following Diagnostic Laparoscopy for Trauma: A National Trauma Data Bank Comparison of University and Community Hospitals

Wissam Raad, MD MRCS, J. Alexander Palesty, MD FACS, Juan A Sanchez, MD FACS. The Stanley J. Dudrick Department of Surgery, Saint Mary’s Hospital, Waterbury, CT

INTRODUCTION– Diagnostic laparoscopy is becoming increasingly popular at ruling out intra-abdominal injuries in hemodynamically normal trauma patients. It is usually utilized to prevent unnecessary exploratory laparotomies with their associated higher morbidity and cost. The goal of this study is to compare outcomes of diagnostic laparoscopy for trauma among community and university hospitals. METHODS– The National Trauma Data Bank between 2002 and 2007 (NTDB 7.2) was queried for all patients who underwent diagnostic laparoscopy in levels I and II community and university teaching centers. Comparisons were made reviewing hospital length of stay (LOS), intensive care unit LOS, ventilator days, major complication rate (pulmonary embolism, pneumonia, lower extremity deep vein thrombosis, pneumothorax, and wound infection), mortality, discharge pattern, and whether a laparotomy was performed in the same admission. Student t tests were used to determine statistical significance defined as P < 0.05. RESULTS– We identified 2674 cases (1674 performed in university centers, and 1000 from community centers). Severity of injuries and patients’ characteristics were identified with GCS, systolic blood pressure, and Injury Severity Score (ISS) in the emergency department. The mean ISS approached 9 in university centers and 11 in community centers. The average number of hours to procedure was 26 for university centers and 35 for community centers. Average LOS was 7 and 8 and the average number of ICU days was 3 and 4 days for university and community centers respectively. Mortality rate was 1.5% and 2.1%. 18.5% of patients in university centers, and 24.4% in community centers had a laparotomy. The complications rate was low and similar between both groups. (Data is summarized in figure 1 and tables 1, 2, & 3). CONCLUSION– The comparisons between community and university hospitals in Level I and II trauma centers demonstrate no significant difference in terms of outcomes and complication rate in relation to diagnostic laparoscopy. LOS, ICU admissions and ventilator days were higher in community hospitals, however, there are multiple variables affecting those values including the higher ISS of the population presenting to community centers. University as well as community trauma centers should be encouraged to utilize diagnostic laparoscopy for trauma when indicated.