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Outcomes after single-look trauma laparotomy

A large population-based study

Bowie, Jason M., MD; Badiee, Jayraan, MPH; Calvo, Richard Y., PhD; Sise, Michael J., MD; Wessels, Lyndsey E., MD; Butler, William J., MD; Dunne, Casey E., MPH; Sise, C. Beth, MSN; Bansal, Vishal, MD

Journal of Trauma and Acute Care Surgery: April 2019 - Volume 86 - Issue 4 - p 565–572
doi: 10.1097/TA.0000000000002167
AAST 2018 PODIUM PAPER
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BACKGROUND Outcomes following damage control laparotomy for trauma have been studied in detail. However, outcomes following a single operation, or “single-look trauma laparotomy” (SLTL), have not. We evaluated the association between SLTL and both short-term and long-term outcomes in a large population-based data set.

METHODS The California Office of Statewide Health Planning and Development patient discharge database was evaluated for calendar years 2007 through 2014. Injured patients with SLTL during their index admission were identified using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. Diagnosis and procedure codes were used to identify specific abdominal organ injuries, surgical interventions, and perioperative complications. Subsequent acute care admissions were examined for postoperative complications and related surgical interventions. Clinical characteristics, injuries, surgical interventions, and outcomes were analyzed by mechanism of injury.

RESULTS There were 2113 patients with SLTL during their index admission; 712 (33.7%) had at least one readmission to an acute care facility. Median time to first readmission was 110 days. Penetrating mechanism was more common than blunt (60.6% vs. 39.4%). Compared to patients with penetrating injury, blunt-injured patients had a significantly higher median Injury Severity Score (9 vs. 18, p < 0.0001) and a significantly higher mortality rate during the index admission (4.1% vs. 27.0%, p < 0.0001). More than 30% of SLTL patients requiring readmission had a surgery-related complication. The most common primary reasons for readmission were bowel obstruction (17.7%), incisional hernia (11.8%), and infection (9.1%). There was no significant association between mechanism of injury and development of surgery-related complications requiring readmission.

CONCLUSIONS Patients with SLTL had postinjury morbidity and mortality, and more than 30% required readmission. Complication rates for SLTL were comparable to those reported for emergency general surgery procedures. Patients should be educated on signs and symptoms of the most common complications before discharge following SLTL. Further investigation should focus on the factors associated with the development of these complications.

LEVEL OF EVIDENCE Prognostic and epidemiologic study, level III.

From the Trauma Service (J.M.B., J.B., R.Y.C., M.J.S., L.E.W., W.J.B., C.E.D., C.B.S., V.B.), Scripps Mercy Hospital, San Diego, California.

This study was presented as a podium presentation at the 77th Annual Meeting of the American Association for the Surgery of Trauma and the 4th World Trauma Congress on September 26, 2018, in San Diego, California.

Address for reprints: Michael J. Sise, MD, Trauma Service (MER62), Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA 92103; email: sise.mike@scrippshealth.org.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

© 2019 Lippincott Williams & Wilkins, Inc.