Comparison between operative management versus non-operative management in patients with blunt abdominal injury in National Trauma Registry of Iran

Abstract

Background Trauma is one of the leading causes of death worldwide. Severe abdominal injuries cause one-fifth of injury mortality. Non-operative management (NOM) or operative management (OM) is a primary challenge in abdominal injuries. In this study, we aimed to compare NOM and OM outcomes in patients with blunt abdominal injuries in the National Trauma Registry of Iran (NTRI). Method This cross-sectional study was conducted with data from the NTRI from July 24th, 2016, to May 21st, 2023. All patients with an abdominal injury by road traffic crash (RTC), falls, hit or bodily fore, and assault with blunt objects were admitted to trauma registry member hospitals across the country according to the NTRI criteria included in this study. Results Liver, spleen, and kidney single-organ injuries managed non-operative more than operative 78 (75.7%), 101 (74.3%), and 34 (89.5%) vs. 25 (24.3%), 35 (25.7%), and 4 (10.5%) (P = 0.572, 0.845, and 0.019). Among multi-organ abdomen injuries, kidney injuries alongside spleen or liver injuries are managed non-operative more than operative. In the multivariate logistic regression model after adjustment, multi-organ abdomen injuries increased the chance of OM 3.57 times compared to NOM [OR:0.28, 95% CI: 0.171 to 0.489, p < 0.001]. Multiple logistic regression after adjustment revealed NOM did not increase mortality and decreased ICU admission compared to the OM. Conclusion We observed that NOM had no worse outcomes than OM. The liver, spleen, and kidney are mainly managed by non-operatives.