title: Bowel obstructions and incisional hernias following trauma laparotomy and the nonoperative therapy of solid organ injuries: A retrospective population-based analysis.
abstract: BACKGROUND
  Small bowel obstruction (SBO) and incisional hernia (IH) represent the most common long-term complications of laparotomy. They may also be more common among injured patients than for elective/nontrauma emergency scenarios. Unfortunately, the population-based incidence of SBO and IH following trauma laparotomy is unknown. The aim of this study was to define the long-term, population-based incidence of SBO and IH following both trauma laparotomy as well as the nonoperative therapy of solid organ injuries.
  
  
  METHODS
  All injured patients admitted to a Level 1 trauma center (2002-2013) who underwent (1) a laparotomy or nonoperative care of (2) splenic and/or (3) hepatic injuries were linked with the Alberta Health Services Discharge Database to identify all readmissions for subsequent SBO and/or IH within the province. Standard statistical methodology was used (p < 0.05).
  
  
  RESULTS
  Of 484 patients who underwent a trauma laparotomy, 29 (6%) and 42 (9%) required readmission for SBO and IH, respectively (0.13 SBO and 0.10 IH admissions per patient year). Patients who underwent nonoperative management of their liver and/or spleen injuries displayed long-term SBO rates of 1% (6 of 619) and 0.7% (4 of 606), respectively. The rate of SBO and IH in patients with unnecessary laparotomies was equivalent to therapeutic procedures (p = 0.183). Topical hemostatic agents, repeat laparotomies, and injury pattern did not alter SBO or IH rates (p > 0.05).
  
  
  CONCLUSIONS
  The population-based, long-term rate of clinically relevant SBO and IH following trauma laparotomies is 15%. This increases to 19% on a per-admission basis. Nontherapeutic scenarios, injury pattern, topical hemostatics, and open abdomens did not alter complication rates.
  
  
  METHODS
  Therapeutic study, level IV.
authors: From the Department of Surgery (T.L., C.R.-M., A.R.M., E.D., A.W.K., C.G.B.), University of` Calgary, Calgary, Alberta, Canada; Department of Surgery (P.N., A.J.N.), University of Cape Town, Cape Town, South Africa.
authors: Ting
authors: T
authors: Li
authors: Connal
authors: C
authors: Robertson-More
authors: Anthony R
authors: AR
authors: Maclean
authors: Elijah
authors: E
authors: Dixon
authors: Pradeep
authors: P
authors: Navsaria
authors: Andrew J
authors: AJ
authors: Nicol
authors: Andrew W
authors: AW
authors: Kirkpatrick
authors: Chad G
authors: CG
authors: Ball
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D005260:Female; D046449:Hernia, Abdominal / Q000453:epidemiology*; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology*; D007421:Intestine, Small; D007813:Laparotomy; D008099:Liver / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D014193:Trauma Centers; D016896:Treatment Outcome