Gianmaria Rausch (Zurich / CH), Yannik Kalbas (Zurich / CH), Valentin Neuhaus (Zurich / CH), Roman Pfeifer (Zurich / CH), Hans-Christoph Pape (Zurich / CH), Felix Karl-Ludwig Klingebiel (Zurich / CH), Michel Paul Johan Teuben (Zurich / CH)
Introduction
Blunt abdominal trauma is common in polytrauma patients. Surgical intervention is indicated for haemodynamically relevant intra-abdominal injuries and hollow organ injuries. Imaging may delay surgery and the impact of timing of surgery on outcome is unclear. The aim of the current study is to determine the impact of time to laparotomy on outcome in polytrauma patients.
Materials & Methods
All adult polytrauma patients undergoing emergency laparotomy for blunt abdominal trauma admitted between 1996 and 2020 were identified from our prospective trauma registry. Patients were stratified into two groups based on the time elapsed from admission to emergency surgery: Group 1h: ≤60 min and Group 1-3h: 60-180 minutes. Outcome parameters included: LOS, LOS/ICU, ventilation time, complications and mortality. Adjusted logistic regression was used to assess independent predictive parameters for mortality.
Results
190 polytraumatised patients with a mean age of 42.29 years (±17.06) and a median ISS of 36 (IQR: 19) were included, with 95 patients in each group. Patients in group 1h were characterized by impaired haemodynamic status and higher ISS. Mortality rates were also significantly different between groups (1h: 51.6% vs. 1-3h: 26.3%, p=0.0006). The adjusted regression model showed that time to emergency laparotomy was not an independent predictor of mortality, but increased ISS (OR=1.04, p=0.049) and age (OR=1.03, p=0.037) and decreased systolic blood pressure (OR=0.98, p=0.025).
Conclusion
Patients who underwent laparotomy within the first hour were more physiologically unstable than those who underwent laparotomy later, which may explain the increased mortality in this group. Timing of surgery did not show an independent association with mortality when laparotomy was performed within 3 hours of admission. Future research should focus on determining the role of delayed laparotomy on outcome in specific subgroups of patients (such as geriatric patients).
No
We use cookies on our website. Cookies are small (text) files that are created and stored on your device (e.g., smartphone, notebook, tablet, PC). Some of these cookies are technically necessary to operate the website, other cookies are used to extend the functionality of the website or for marketing purposes. Apart from the technically necessary cookies, you are free to allow or not allow cookies when visiting our website.