A characterization of trauma laparotomies in a scandinavian setting: an observational study

Abstract

Background Despite treatment advances, trauma laparotomy continuous to be associated with significant morbidity and mortality. Most of the literature originates from high volume centers, whereas patient characteristics and outcomes in a Scandinavian setting is not well described. The objective of this study is to characterize treatments and outcomes of patients undergoing trauma laparotomy in a Scandinavian setting and compare this to international reports. Methods A retrospective study was performed in the Copenhagen University Hospital, Rigshospitalet (CUHR). All patients undergoing a trauma laparotomy within the first 24 h of admission between January 1st 2019 and December 31st 2020 were included. Collected data included demographics, trauma mechanism, injuries, procedures performed and outcomes. Results A total of 1713 trauma patients were admitted to CUHR of which 98 patients underwent trauma laparotomy. Penetrating trauma accounted for 16.6% of the trauma population and 66.3% of trauma laparotomies. Median time to surgery after arrival at the trauma center (TC) was 12 min for surgeries performed in the Emergency Department (ED) and 103 min for surgeries performed in the operating room (OR). A total of 14.3% of the procedures were performed in the ED. A damage control strategy (DCS) approach was chosen in 18.4% of cases. Our rate of negative laparotomies was 17.3%. We found a mortality rate of 8.2%. The total median length of stay was 6.1 days. Conclusion The overall rates, findings, and outcomes of trauma laparotomies in this Danish cohort is comparable to reports from similar Western European trauma systems.

Laparoscopy for hemodynamic stable penetrating abdominal trauma. An exploratory study in a European setting.

“…Previous studies have demonstrated a rate of negative laparotomy of up to 61% [3,4]. A recent report from our institution has reported a 17,3% rate of negative laparotomies when combining both blunt and penetrating trauma in a Scandinavian setting [5]. Studies have suggested that a very high proportion, and up to 45% of negative laparotomies, can be avoided with the use of laparoscopy for penetrating abdominal trauma [3].…”

Evaluating patient factors, operative management and postoperative outcomes in trauma laparotomy patients worldwide: a protocol for a global observational multicentre trauma study

“…Data suggest that 30-day mortality rates following trauma laparotomy in high-income countries (HICs) are around 9%3 and in low-income and miffle-income countries (LMICs) are around 17%17–19; using an alpha value=0.05 and power=80%, to show a difference between HIC and LMIC settings, a total of 552 patients are required to be recruited to the study. Based on data from other observational studies,3 7 8 we would expect over a 30-day observation period each centre to commit around 3–5 patients to the study. Therefore, with around 150 recruiting centres from our pre-existing research network, we would expect to meet the sample size required.…”

“…In the context of global abdominal trauma, both blunt and penetrating, the trauma laparotomy is the most commonly performed operation; it can be used both as a means to access identified injuries to organs within the abdomen and pelvis, such as life-threatening bleeding from vessels or solid organs, or contamination from hollow viscus injuries, or for exploratory diagnostic reasons, where cross-sectional imaging may not be easily feasible or available. While mortality rates following a trauma laparotomy are substantial, ranging between 8% and 40%,3–8 in recent years the role of damage control resuscitation has transformed trauma care, with significant reduction in mortality and morbidity to trauma patients being observed 9–11. However, the standard of care and variation in practice occurring globally for patients undergoing a trauma laparotomy remain relatively unknown.…”