Complications after therapeutic trauma laparotomy.
BACKGROUND
Therapeutic trauma laparotomy (TTL) is a common emergency procedure after traumatic abdominal injury, but it can lead to complications and even death. We explored the role of the time from emergency department (ED) arrival to surgical intervention as a predictor of complications and mortality from TTL.


METHODS
This is a retrospective study of 175 patients receiving TTL between July 1997 and October 2003 in a Level I teaching hospital serving a primarily rural population. Mortality after TTL and complications, both general and abdominal, were the main outcomes. Time from ED arrival to operation was the primary exposure. Confounders, including time from injury to ED arrival, age, gender, injury severity, and patient status, were controlled in logistic models.


RESULTS
Of the 175 TTL patients, 23 (13.1%) died, 102 (58.3%) had abdominal complications, and 119 (68.0%) had general complications. Controlling for confounders, patients whose operation began more than 1 hour after ED arrival were 11.3 (95% CI=2.2 to 58.8) times more likely to die and 3.1 (95% CI=1.44 to 6.60) times more likely to have complications.


CONCLUSIONS
The traumatologist has little control over patient treatment and transfer before ED arrival. After arrival the traumatologist can reduce negative outcomes by reducing the time for patient assessment and start of TTL, when warranted.
Choi
Kent C
KC
Department of Surgery, University of Iowa, Iowa City, USA.
Peek-Asa
Corinne
C
Lovell
Matthew
M
Torner
James C
JC
Zwerling
Craig
C
Kealey
Gerald P
GP
D000007:Abdominal Injuries / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D015599:Trauma Severity Indices