Unnecessary laparotomies for trauma: a prospective study of morbidity.
OBJECTIVE
Despite advances in diagnostic techniques, unnecessary laparotomies (no repairs/no drains) are still performed in trauma centers. The true risks of such procedures are unclear. Our hypothesis was that the overall incidences of complications after an unnecessary laparotomy for trauma that have been reported in the literature were significant underestimates because of flaws in study design. To test our hypothesis, a prospective study to record all perioperative complications in patients undergoing an unnecessary laparotomy for trauma was performed.


METHODS
Prospective case series.


RESULTS
The main outcome measures were perioperative complications. An unnecessary laparotomy was performed in 254 patients who sustained trauma. The mechanism of injury was a penetrating wound in 98% of the patients. Complications occurred in 41.3% of the patients (n = 105) and included atelectasis (15.7%), postoperative hypertension that required medical treatment (11.0%), pleural effusion (9.8%), pneumothorax (5.1%), prolonged ileus (4.3%), pneumonia (3.9%), surgical wound infection (3.2%), small bowel obstruction (2.4%), urinary infection (1.9%), and others. Complication rates for patients who did (n = 111) and did not (n = 143) have an associated injury were 61.3% and 25.9%, respectively (p = 0.0001). Complications occurred in 19.7% of 81 patients who did not have an associated injury and who did not have intraperitoneal or retroperitoneal penetration. The mortality rate for the entire series was 0.8% and was unrelated to the unnecessary laparotomies.


CONCLUSIONS
Unnecessary laparotomies for trauma result in a significant morbidity when complications are recorded prospectively. Current efforts to reduce the incidence of these unnecessary procedures without increasing that of missed injuries are obviously worthwhile.
Renz
B M
BM
Grady Memorial Hospital, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Feliciano
D V
DV
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D007813:Laparotomy / Q000009:adverse effects* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000601:surgery*