Trauma Laparotomy in the UK: A Prospective National Service Evaluation

Marsden, Max; Vulliamy, Paul; Carden, Rich; Naumann, David N; Davenport, Ross

doi:10.1016/j.jamcollsurg.2021.04.031

Cited by 16 publications

(17 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We identified an overall hospital mortality rate of 7.1%. This is a large decrease from the near 20% rate of death following ETL from separate studies by Tang et al, 11 Harvin et al, 7 and Clarke et al, 8 but similar to the near 9% mortality rate in more recent work from the United Kingdom by Marsden 9,10,38 . Similarly, our hospital mortality rate for ETL among hypotensive patients was lower at 15% compared with more than 40% as seen in previous works.…”

Section: Discussionsupporting

confidence: 89%

“…This is a large decrease from the near 20% rate of death following ETL from separate studies by Tang et al, 11 Harvin et al, 7 and Clarke et al, 8 but similar to the near 9% mortality rate in more recent work from the United Kingdom by Marsden. 9,10,38 Similarly, our hospital mortality rate for ETL among hypotensive patients was lower at 15% compared with more than 40% as seen in previous works. Potentially, our findings may simply represent a continued evolution in improvement of care for the severely injured patient requiring ETL, especially the liberal use of blood products and restriction of crystalloid.…”

Section: Discussionsupporting

confidence: 73%

“…Subpopulations consisting of patients with an Abbreviated Injury Scale score of the abdomen (AIS-abdomen) ≥3, lactate level on arrival ≥3 mMol/L, and both AIS-abdomen ≥3 and admission lactate level ≥3 mMol/L were separately compared. 9,24,25 An additional subpopulation of patients without severe traumatic brain injury (AIS-head <3) was also compared between surgeons. Surgeons were also dichotomized, and mortality was compared among high and low volume or more and less experienced by median case number and years from training, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…The most common cause of preventable death is hemorrhage, [2][3][4][5][6] yet mortality among patients with hemorrhagic shock requiring emergent trauma laparotomy (ETL) remains above 40%, a figure that has not changed for the last 20 years. [7][8][9][10] Despite this fact, there are no standardized measures of the impact of the individual trauma surgeon related to the performance of ETL in our national reports. The ETL remains the signature procedure of traumatology and likely retains the greatest potential for the individual surgeon to impact preventable death.…”

mentioning

confidence: 99%

See 3 more Smart Citations

It is time to look in the mirror: Individual surgeon outcomes after emergent trauma laparotomy

Jansen

Uhlich

et al. 2022

J Trauma Acute Care Surg

View full text Add to dashboard Cite

BACKGROUND:Multiple quality indicators are used by trauma programs to decrease variation and improve outcomes. However, little if any provider level outcomes related to surgical procedures are reviewed. Emergent trauma laparotomy (ETL) is arguably the signature case that trauma surgeons perform on a regular basis, but few data exist to facilitate benchmarking of individual surgeon outcomes. As part of our comprehensive performance improvement program, we examined outcomes by surgeon for those who routinely perform ETL. METHODS:A retrospective cohort study of patients undergoing ETL directly from the trauma bay by trauma faculty from December 2019 to February 2021 was conducted. Patients were excluded from mortality analysis if they required resuscitative thoracotomy for arrest before ETL. Surgeons were compared by rates of damage control and mortality at multiple time points. RESULTS:There were 242 ETL (7-32 ETLs per surgeon) performed by 14 faculties. Resuscitative thoracotomy was performed in 7.0% (n = 17) before ETL. Six patients without resuscitative thoracotomy died intraoperatively and damage-control laparotomy was performed on 31.9% (n = 72 of 226 patients). Mortality was 4.0% (n = 9) at 24 hours and 7.1% (n = 16) overall. Median Injury Severity Score ( p = 0.21), new injury severity score ( p = 0.21), and time in emergency department were similar overall among surgeons ( p = 0.15), while operative time varied significantly (40-469 minutes; p = 0.005). There were significant differences between rates of individual surgeon's mortality (range [hospital mortality], 0-25%) and damage-control laparotomy (range, 14-63%) in ETL. CONCLUSION:Significant differences exist in outcomes by surgeon after ETL. Benchmarking surgeon level performance is a necessary natural progression of quality assurance programs for individual trauma centers. Additional data from multiple centers will be vital to allow for development of more granular quality metrics to foster introspective case review and quality improvement.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 73%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

It is time to look in the mirror: Individual surgeon outcomes after emergent trauma laparotomy

Jansen

Uhlich

et al. 2022

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…Penetrating injury is infrequent in most western European countries, whereas higher rates are seen in the US and South Africa [26,27]. In the Northern European countries, penetrating trauma is seen in 5-14% [28][29][30][31][32], and 37-58% [29,33,34] for patients undergoing trauma laparotomy, with gunshots accounting for 5-36% [28,[35][36][37][38]. In our study, penetrating trauma accounted for 16,6% of the trauma population and 66.3% for patients undergoing laparotomy.…”

Section: Discussionmentioning

confidence: 58%

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

Bentin

Possfelt-Møller

Svenningsen

et al. 2022

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

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.

show abstract

Prehospital Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Exsanguinating Subdiaphragmatic Hemorrhage

Lendrum,

Perkins,

Marsden

et al. 2024

JAMA Surg

View full text Add to dashboard Cite

ImportanceHemorrhage is the most common cause of preventable death after injury. Most deaths occur early, in the prehospital phase of care.ObjectiveTo establish whether prehospital zone 1 (supraceliac) partial resuscitative endovascular balloon occlusion of the aorta (Z1 P-REBOA) can be achieved in the resuscitation of adult trauma patients at risk of cardiac arrest and death due to exsanguination.Design, Setting, and ParticipantsThis was a prospective observational cohort study (Idea, Development, Exploration, Assessment and Long-term follow-up [IDEAL] 2A design) with recruitment from June 2020 to March 2022 and follow-up until discharge from hospital, death, or 90 days evaluating a physician-led and physician-delivered, urban prehospital trauma service in the Greater London area. Trauma patients aged 16 years and older with suspected exsanguinating subdiaphragmatic hemorrhage, recent or imminent hypovolemic traumatic cardiac arrest (TCA) were included. Those with unsurvivable injuries or who were pregnant were excluded. Of 2960 individuals attended by the service during the study period, 16 were included in the study.ExposuresZI REBOA or P-REBOA.Main Outcomes and MeasuresThe main outcome was the proportion of patients in whom Z1 REBOA and Z1 P-REBOA were achieved. Clinical end points included systolic blood pressure (SBP) response to Z1 REBOA, mortality rate (1 hour, 3 hours, 24 hours, or 30 days postinjury), and survival to hospital discharge.ResultsFemoral arterial access for Z1 REBOA was attempted in 16 patients (median [range] age, 30 [17-76] years; 14 [81%] male; median [IQR] Injury Severity Score, 50 [39-57]). In 2 patients with successful arterial access, REBOA was not attempted due to improvement in clinical condition. In the other 14 patients (8 [57%] of whom were in traumatic cardiac arrest [TCA]), 11 successfully underwent cannulation and had aortic balloons inflated in Z1. The 3 individuals in whom cannulation was unsuccessful were in TCA (failure rate = 3/14 [21%]). Median (IQR) pre-REBOA SBP in the 11 individuals for whom cannulation was successful (5 [46%] in TCA) was 47 (33-52) mm Hg. Z1 REBOA plus P-REBOA was associated with a significant improvement in BP (median [IQR] SBP at emergency department arrival, 101 [77-107] mm Hg; 0 of 10 patients were in TCA at arrival). The median group-level improvement in SBP from the pre-REBOA value was 52 (95% CI, 42-77) mm Hg (P &lt; .004). P-REBOA was feasible in 8 individuals (8/11 [73%]) and occurred spontaneously in 4 of these. The 1- and 3-hour postinjury mortality rate was 9% (1/11), 24-hour mortality was 27% (3/11), and 30-day mortality was 82% (9/11). Survival to hospital discharge was 18% (2/11). Both survivors underwent early Z1 P-REBOA.Conclusions and RelevanceIn this study, prehospital Z1 P-REBOA is feasible and may enable early survival, but with a significant incidence of late death.Trial RegistrationClinicalTrials.gov Identifier: NCT04145271

show abstract

Trauma Laparotomy in the UK: A Prospective National Service Evaluation

Cited by 16 publications

References 30 publications

It is time to look in the mirror: Individual surgeon outcomes after emergent trauma laparotomy

It is time to look in the mirror: Individual surgeon outcomes after emergent trauma laparotomy

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

Prehospital Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Exsanguinating Subdiaphragmatic Hemorrhage

Contact Info

Product

Resources

About