Indications, risk factors, and clinical outcomes of relaparotomy after abdominal trauma surgery

Abstract

Background: Relaparotomy following abdominal trauma surgery is a critical intervention associated with significant morbidity and mortality. However, data on relaparotomy in trauma patients remain limited. This study aimed to evaluate the impact of relaparotomy-related factors on prognosis in patients undergoing relaparotomy after abdominal trauma surgery.

Methods: This retrospective study analyzed adult patients who underwent relaparotomy following abdominal trauma surgery at a single center between December 2016 and December 2022. Demographic characteristics, trauma-related features, and perioperative clinical findings were recorded. Statistical analyses were conducted to identify factors associated with in-hospital mortality.

Results: Among 300 patients who underwent abdominal trauma surgery, 106 (35.3%) required relaparotomy. The in-hospital mortality rate was 9.4%. Major indications for relaparotomy included hemorrhage control, hemodynamic instability, and intestinal leaks. Factors significantly associated with increased mortality included age ≥50 years (p=0.020), female sex (p=0.031), blunt trauma (p=0.020), multiple relaparotomies (p=0.023), active hemorrhage during relaparotomy (p<0.001), and fresh frozen plasma transfusion (p=0.046). Additionally, non-survivors demonstrated significantly lower blood pressure (p<0.001) and higher heart rates (p<0.001). They also presented with decreased levels of hemoglobin (p=0.015), platelet counts (p=0.001), and albumin (p<0.001), along with elevated international normalized ratio (INR) (p<0.001) and lactate levels (p<0.001).

Conclusion: This study highlights key factors associated with mortality in patients undergoing relaparotomy after abdominal trauma surgery. Early recognition and optimization of risk factors, along with the management of active hemorrhage, careful monitoring of vital signs and laboratory parameters, and special attention to high-risk groups such as older patients and those with blunt trauma, may improve outcomes in this vulnerable population.