Complications after negative laparotomy for trauma: long-term follow-up in a health maintenance organization

Abstract

Objective: To assess short-term and long-term complication rates after trauma laparotomy in a group of health maintenance organization (Kaiser Permanente) patients.

Design: Retrospective cohort study of patients belonging to Kaiser Permanente.

Materials and methods: Eighty Kaiser patients who underwent a negative or nontherapeutic laparotomy for trauma at a Level I trauma center (University of California, Davis Medical Center (UCDMC)) between April 1989 and May 1994 were identified. Demographic data, past medical history, mechanism of injury, indications for surgery, findings at laparotomy, and short-term complications were abstracted from the UCDMC record. Long-term complications were taken from the Kaiser record.

Measurements: Long-term complications, including small bowel obstruction, hernia, and cosmesis. Short-term complications, including pneumonia, cellulitis, wound infection, prolonged ileus, and urinary tract infection.

Results: The single death in the early postoperative period was not related to the laparotomy. Mean follow-up was 36 +/- 2 months (median, 36 months); 86% had follow-up of at least 1 year. The incidence of short-term complications was 43% in patients with associated extra-abdominal injuries and 20% in patients without associated extra-abdominal injuries (p = 0.17). On long-term follow-up, there were no small bowel obstructions, incisional hernias, or cosmetic problems requiring correction. One patient developed a stitch abscess 6 weeks after the operation.

Conclusions: The incidence of long-term complications after negative or nontherapeutic laparotomy for trauma is low.