Are we doing too many non-therapeutic laparotomies in trauma? An analysis of the National Trauma Data Bank
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Exploratory laparotomy (EL) has been the definitive diagnostic and therapeutic modality for operative abdominal trauma in the US. Recently, many trauma 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 evaluate the incidence of NL in the trauma population in the US and compare the outcomes between DL and NL.
Using ICD-9 codes, the National Trauma Data Bank (2010–2015) was queried for patients undergoing any abdominal surgical intervention. Patients were divided into two groups: diagnostic laparoscopy (DL) and exploratory laparotomy (EL). Hemodynamically unstable patients on arrival and patients with abbreviated injury score (AIS) > 3 were excluded. Patients in EL group without any codes for gastrointestinal, diaphragmatic, hepatic, splenic, vascular, or urological procedures were considered to have undergone NL. After excluding patients who were converted to open from the DL group, multivariate regression models were used to analyze the outcomes of DL vs NL group with respect to mortality, length of stay, and complications.
A total of 3197 patients underwent NL vs 1323 patients who underwent DL. Compared to DL group, the NL group were older (mean age: 35 vs. 31, P < 0.01). Rate of penetrating injury was 77% vs 86% for patients in NL vs DL. On multivariate analysis, NL was associated with increased mortality (OR 4.5, 95% CI 2.1–9.7), higher rate of complications (OR 2.2, 95% CI 1.4–3.3), and a longer hospital stay (OR 2.7, 95% CI 2.1–3.5). NL was also associated with higher rates of pneumonia, VTE, ARDS, and cardiac arrest.
With increasing experience in minimally invasive surgery, DL should be a part of the armamentarium of trauma surgeons. This study supports that in well-selected trauma patients DL has favorable outcomes compared to NL. These findings warrant further investigation.
KeywordsNon-therapeutic laparotomy Diagnostic laparoscopy Trauma Exploratory laparotomy Minimally invasive surgery
Compliance with ethical standards
Adeel A. Shamim, Suhail Zeineddin, Ahmad Zeineddin, Olubode A. Olufajo, Gregory O. Mathelier, Edward E. Cornwell III, Terrence Fullum and Daniel Tran have no conflicts of interest or financial ties to disclose.
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