The distinct and secondary harmful effect of pelvic and extremity injury on the outcome of laparotomy for trauma.
OBJECTIVE
Extra-abdominal injury negatively affects the outcome of abdominal injury following trauma laparotomy.


METHODS
Retrospective review of 920 consecutive patients receiving laparotomy for trauma who survived more than 24 h between January 1989 and May 1998 at a Level 1 trauma center. Major abdominal complications (MAC) were defined as: abdominal compartment syndrome (ACS), abscess/peritonitis, enterocutaneous fistula, necrotizing fasciitis, and necrotizing pancreatitis.


METHODS
Univariant and multivariant logistic regression were used to identify predictors of MAC.


RESULTS
Sixty-nine patients (7.5%) developed one or more MAC. Patients who developed MAC had higher injury severity scores (ISS), abdominal trauma indices (ATI), and blood transfusions in the first 24 h (PRCs) than patients who did not develop MAC. Patients with MAC were more likely to have suffered a thoracic or pelvic injury with an abbreviated injury scale (AIS) > or =3 and were more likely to have received an extremity injury (AIS > or =3) operation than patients without MAC. Independent predictors of MAC in multivariant analysis included colon injury (AIS > or =3) [odds ratio (OR) = 3.1, 95% confidence interval (CI) 1.5- 6.3)], pelvic injury (AIS > or =3) or operation for extremity injury (AIS > or =3) [OR 2.9, 95% CI 1.5-5.3], and ATI (OR = 1.03 for each 10 unit increase in ATI, 95% CI 1.02-1.05). PRCs did not independently predict MAC.


CONCLUSIONS
The outcome of laparotomy for trauma (both blunt and penetrating) is negatively affected by a severe pelvic injury or a severe extremity injury operation independent of initial hemorrhage and abdominal injury severity.
Prince
Rebecca A
RA
Department of Surgery, Trauma/Critical Care Section, Oregon Health & Science University, Portland, Oregon 97239, USA.
Hoffman
Christopher J
CJ
Scanlan
Richard M
RM
Mayberry
John C
JC
D000007:Abdominal Injuries / Q000150:complications / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D005121:Extremities / Q000293:injuries; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000453:epidemiology*; D009922:Oregon / Q000453:epidemiology; D010384:Pelvic Bones / Q000293:injuries; D010388:Pelvis / Q000293:injuries; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome