"Never be wrong": the morbidity of negative and delayed laparotomies after blunt trauma

Abstract

Background: The objective of this study was to investigate the 30-day morbidity of a negative laparotomy (NEGLAP) in blunt abdominal trauma. No previous work has exclusively examined blunt abdominal trauma patients, used a control group, or determined the complication burden incurred by a NEGLAP.

Methods: In this retrospective cohort study of a prospectively maintained database, demographics, Injury Severity Score, Revised Trauma Score (TRISS), hospital length of stay, mortality, and findings at laparotomy (LAP) were analyzed. Patients were assigned to four groups as follows: NEGLAP (n = 28), positive LAP (n = 126), delay to LAP (DELAY, n = 18), and no LAP (NOLAP, n = 427). Complications during hospitalization and 30 days postdischarge were extracted from our complication database and adjusted for severity using a complication scoring system (Complication Impact Score [CIS]). The effect of LAP on the log transformed CIS was assessed using a linear regression model, controlling for age and TRISS.

Results: Complications per patient ranged from 1.73 (DELAY) to 0.38 (NOLAP), and the average CIS per patient ranged from 7.29 (NEGLAP) to 1.8 (NOLAP). When controlled for TRISS and age, NEGLAP did not significantly increase the CIS (p = 0.620), whereas positive LAP (p = 0.004) and DELAY (p = 0.034) were associated with a significant increase in CIS.

Conclusions: When controlled for TRISS and age, NEGLAP does not increase the complication burden compared with NOLAP. In blunt abdominal trauma patients, operations to establish diagnosis do not add significantly to complication burden.