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Complications after laparotomy for trauma: a retrospective analysis in a level I trauma centre

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Abstract

Purpose

Laparotomy is a potential life-saving procedure after traumatic abdominal injury. There is limited literature about morbidity and mortality rates after trauma laparotomy. The primary aim of this study is to describe the complications which may occur due to laparotomy for trauma.

Methods

Retrospective evaluated single-centre study with data registry up to 1 year after initial laparotomy for trauma was performed in a level 1 trauma centre in The Netherlands. Between January 2000 and January 2011, a total of 2390 severely injured trauma patients (ISS ≥ 16) were transported to the VUMC. Patient demographics; mechanism of injury; injury patterns defined by Abbreviated Injury Scale (AIS), Injury Severity Score (ISS) and Revised Trauma Score (RTS); surgical interventions and findings; and morbidity and mortality were documented.

Results

A total of 92 trauma patients who underwent a trauma laparotomy met the inclusion criteria. Of these patients, 71 % were male. Median age was 37 years. Median ISS was 27. Mechanisms of injury comprised of car accidents (20 %), fall from height (17 %), motorcycle accidents (12 %), pedestrian/cyclist hit by a vehicle (9 %) and other in three patients (5 %). Penetrating injuries accounted for 37 % of the injuries, consisting of stab wounds (21 %) and gunshot wounds (16 %). Complications classified by the Clavien-Dindo Classification of Surgical Complications showed grade I complications in 21 patients (23 %), grade II in 36 patients (39 %), grade III in 21 patients (23 %), grade IV in 2 patients (2 %) and grade V in 16 patients (17 %).

Conclusion

Laparotomy for trauma has a high complication rate resulting in significant morbidity and mortality. Most events occur in the early postoperative period. Further prospective research needs to be conducted in order to identify possibilities to improve care in the future.

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References

  1. Bauer R, Steiner M (2012) Injuries in the European Union 2009-Report Statistic Summary 2005–2007 featuring the EU, Injury Database (IDB)

  2. Netherlands TcNT (2014) Annual databases 2005–2010

  3. Morrison JE, Wisner DH, Bodai BI (1996) Complications after negative laparotomy for trauma: long-term follow-up in a health maintenance organization. J Trauma 41(3):509–513

    Article  CAS  PubMed  Google Scholar 

  4. Renz BM, Feliciano DV (1995) Unnecessary laparotomies for trauma: a prospective study of morbidity. J Trauma 38(3):350–356

    Article  CAS  PubMed  Google Scholar 

  5. Ross SE, Dragon GM, O’Malley KF, Rehm CG (1995) Morbidity of negative coeliotomy in trauma. Injury 26(6):393–394

    Article  CAS  PubMed  Google Scholar 

  6. Weigelt JA, Kingman RG (1988) Complications of negative laparotomy for trauma. Am J Surg 156(6):544–547

    Article  CAS  PubMed  Google Scholar 

  7. Ordonez C, Garcia A, Parra MW, Scavo D, Pino LF, Millan M, Badiel M, Sanjuan J, Rodriguez F, Ferrada R, Puyana JC (2014) Complex penetrating duodenal injuries: less is better. J Trauma Acute Care Surg 76(5):1177–1183. doi:10.1097/TA.0000000000000214

    Article  PubMed  Google Scholar 

  8. Copes WS, Champion HR, Sacco WJ, Lawnick MM, Gann DS, Gennarelli T, MacKenzie E, Schwaitzberg S (1990) Progress in characterizing anatomic injury. J Trauma 30(10):1200–1207

    Article  CAS  PubMed  Google Scholar 

  9. Baker SP, O’Neill B, Haddon W Jr, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14(3):187–196

    Article  CAS  PubMed  Google Scholar 

  10. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME (1989) A revision of the Trauma Score. J Trauma 29(5):623–629

    Article  CAS  PubMed  Google Scholar 

  11. Choi KC, Peek-Asa C, Lovell M, Torner JC, Zwerling C, Kealey GP (2005) Complications after therapeutic trauma laparotomy. J Am Coll Surg 201(4):546–553

    Article  PubMed  Google Scholar 

  12. Hatch QM, Osterhout LM, Ashraf A, Podbielski J, Kozar RA, Wade CE, Holcomb JB, Cotton BA (2011) Current use of damage-control laparotomy, closure rates, and predictors of early fascial closure at the first take-back. J Trauma 70(6):1429–1436

    Article  PubMed  Google Scholar 

  13. Weber DG, Bendinelli C, Balogh ZJ (2014) Damage control surgery for abdominal emergencies. Br J Surg 101(1):e109–e118. doi:10.1002/bjs.9360

    Article  CAS  PubMed  Google Scholar 

  14. Crookes BA, Shackford SR, Gratton J, Khaleel M, Ratliff J, Osler T (2010) “Never be wrong”: the morbidity of negative and delayed laparotomies after blunt trauma. J Trauma 69(6):1386–1391

    Article  PubMed  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed Central  PubMed  Google Scholar 

  16. Lenz A, Franklin GA, Cheadle WG (2007) Systemic inflammation after trauma. Injury 38(12):1336–1345. doi:10.1016/j.injury.2007.10.003

    Article  PubMed  Google Scholar 

  17. Gentile LF, Cuenca AG, Efron PA, Ang D, Bihorac A, McKinley BA, Moldawer LL, Moore FA (2012) Persistent inflammation and immunosuppression: a common syndrome and new horizon for surgical intensive care. J Trauma Acute Care Surg 72(6):1491–1501. doi:10.1097/TA.0b013e318256e000

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. DICA S (2014) Rapportages 2013 de zorg in de etalage. Leiden

  19. Tadlock MD, Karamanos E, Skiada D, Inaba K, Talving P, Senagore A, Demetriades D (2013) Emergency surgery for acute diverticulitis: which operation? A National Surgical Quality Improvement Program study. J Trauma Acute Care Surg 74(6):1385–1391. doi:10.1097/TA.0b013e3182924a82, quiz 1610

    Article  PubMed  Google Scholar 

  20. Moore FA, Catena F, Moore EE, Leppaniemi A, Peitzmann AB (2013) Position paper: management of perforated sigmoid diverticulitis. World J Emerg Surg WJES 8(1):55. doi:10.1186/1749-7922-8-55

    Article  Google Scholar 

  21. Clarke A, Murdoch H, Thomas MJ, Cook TM, Peden CJ (2011) Mortality and postoperative care after emergency laparotomy. Eur J Anaesthesiol 28(1):16–19. doi:10.1097/EJA.0b013e32833f5389

    Article  PubMed  Google Scholar 

  22. Prince RA, Hoffman CJ, Scanlan RM, Mayberry JC (2005) The distinct and secondary harmful effect of pelvic and extremity injury on the outcome of laparotomy for trauma. J Surg Res 124(1):3–8

    Article  PubMed  Google Scholar 

  23. Croce MA, Fabian TC, Stewart RM, Pritchard FE, Minard G, Kudsk KA (1992) Correlation of abdominal trauma index and injury severity score with abdominal septic complications in penetrating and blunt trauma. J Trauma 32(3):380–387

    Article  CAS  PubMed  Google Scholar 

  24. Wang SY, Liao CH, Fu CY, Kang SC, Ouyang CH, Kuo IM, Lin JR, Hsu YP, Yeh CN, Chen SW (2014) An outcome prediction model for exsanguinating patients with blunt abdominal trauma after damage control laparotomy: a retrospective study. BMC Surg 14:24. doi:10.1186/1471-2482-14-24

    Article  PubMed Central  PubMed  Google Scholar 

  25. Fraga GP, Silva FH, Almeida NA, Curi JC, Mantovani M (2008) Blunt abdominal trauma with small bowel injury: are isolated lesions riskier than associated lesions? Acta Cir Bras 23(2):192–197

    PubMed  Google Scholar 

  26. Schnuriger B, Inderbitzin D, Schafer M, Kickuth R, Exadaktylos A, Candinas D (2009) Concomitant injuries are an important determinant of outcome of high-grade blunt hepatic trauma. Br J Surg 96(1):104–110

    Article  CAS  PubMed  Google Scholar 

  27. Bryceland JK, Keating JF (2008) Laparotomy and unstable pelvic fractures. Injury 39(8):853–857

    Article  CAS  PubMed  Google Scholar 

  28. Matthes G, Stengel D, Bauwens K, Seifert J, Rademacher G, Mutze S, Ekkernkamp A (2006) Predictive factors of liver injury in blunt multiple trauma. Langenbecks Arch Surg 391(4):350–354

    Article  PubMed  Google Scholar 

  29. Asensio JA, Chahwan S, Hanpeter D, Demetriades D, Forno W, Gambaro E, Murray J, Velmahos G, Marengo J, Shoemaker WC, Berne TV (2000) Operative management and outcome of 302 abdominal vascular injuries. Am J Surg 180(6):528–533

    Article  CAS  PubMed  Google Scholar 

  30. Brenner M, Bochicchio G, Bochicchio K, Ilahi O, Rodriguez E, Henry S, Joshi M, Scalea T (2011) Long-term impact of damage control laparotomy: a prospective study. Arch Surg 146(4):395–399

    Article  PubMed  Google Scholar 

  31. Weinberg JA, McKinley K, Petersen SR, Demarest GB, Timberlake GA, Gardner RS (2003) Trauma laparotomy in a rural setting before transfer to a regional center: does it save lives? J Trauma 54(5):823–826

    Article  PubMed  Google Scholar 

  32. Helling TS (2003) The challenges of trauma care in the rural setting. Mo Med 100(5):510–514

    PubMed  Google Scholar 

  33. Heuer M, Hussmann B, Kaiser GM, Lefering R, Paul A, Lendemans S, Trauma Registry of DGU (2013) Abdominal vascular trauma in 760 severely injured patients. Eur J Trauma Emerg Surg 39(1):47–55. doi:10.1007/s00068-012-0234-6

    Article  Google Scholar 

  34. Bain IM, Kirby RM (1998) 10 year experience of splenic injury: an increasing place for conservative management after blunt trauma. Injury 29(3):177–182

    Article  CAS  PubMed  Google Scholar 

  35. Malhotra AK, Ivatury RR, Latifi R (2002) Blunt abdominal trauma: evaluation and indications for laparotomy. Scand J Surg 91(1):52–57

    CAS  PubMed  Google Scholar 

  36. Nishijima DK, Simel DL, Wisner DH, Holmes JF (2012) Does this adult patient have a blunt intra-abdominal injury? JAMA 307(14):1517–1527

    Article  CAS  PubMed  Google Scholar 

  37. Hoff WS, Holevar M, Nagy KK, Patterson L, Young JS, Arrillaga A, Najarian MP, Valenziano CP (2002) Practice management guidelines for the evaluation of blunt abdominal trauma: the East practice management guidelines work group. J Trauma 53(3):602–615

    Article  PubMed  Google Scholar 

  38. Nagy K, Roberts R, Joseph K, An G, Barrett J (1999) Evisceration after abdominal stab wounds: is laparotomy required? J Trauma 47(4):622–624

    Article  CAS  PubMed  Google Scholar 

  39. Biffl WL, Kaups KL, Cothren CC, Brasel KJ, Dicker RA, Bullard MK, Haan JM, Jurkovich GJ, Harrison P, Moore FO, Schreiber M, Knudson MM, Moore EE (2009) Management of patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. J Trauma 66(5):1294–1301

    Article  PubMed  Google Scholar 

  40. Peitzman AB, Ferrada P, Puyana JC (2009) Nonoperative management of blunt abdominal trauma: have we gone too far? Surg Infect (Larchmt) 10(5):427–433

    Article  Google Scholar 

  41. Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, Ivatury RR, Scalea TM (2010) Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma 68(3):721–733

    Article  PubMed  Google Scholar 

  42. Peitzman AB, Richardson JD (2010) Surgical treatment of injuries to the solid abdominal organs: a 50-year perspective from the Journal of Trauma. J Trauma 69(5):1011–1021

    Article  PubMed  Google Scholar 

  43. Biffl WL, Kaups KL, Pham TN, Rowell SE, Jurkovich GJ, Burlew CC, Elterman J, Moore EE (2011) Validating the Western Trauma Association algorithm for managing patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. J Trauma 71(6):1494–1502

    Article  PubMed  Google Scholar 

  44. Schnuriger B, Lam L, Inaba K, Kobayashi L, Barbarino R, Demetriades D (2012) Negative laparotomy in trauma: are we getting better? Am Surg 78(11):1219–1223

    PubMed  Google Scholar 

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Conflicts of interest

None.

Authors’ contributions

All authors have made substantial contributions to all of the following: (1) study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript and critical revision of manuscript. They have given final approval of the version to be submitted.

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Authors and Affiliations

  1. Department of Trauma Surgery, VU University Medical Centre, De Boelelaan 1117, P.O. Box 7057, 1081 HV, Amsterdam, The Netherlands

    Matthijs H. van Gool, Georgios F. Giannakopoulos, Leo M. G. Geeraedts Jr. & Wietse P. Zuidema

  2. Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands

    Elly S. M. de Lange-de Klerk

Authors
  1. Matthijs H. van Gool
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  2. Georgios F. Giannakopoulos
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  3. Leo M. G. Geeraedts Jr.
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Correspondence to Matthijs H. van Gool.

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van Gool, M.H., Giannakopoulos, G.F., Geeraedts, L.M.G. et al. Complications after laparotomy for trauma: a retrospective analysis in a level I trauma centre. Langenbecks Arch Surg 400, 83–90 (2015). https://doi.org/10.1007/s00423-014-1260-0

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