Trauma Laparotomy in the UK: A Prospective National Service Evaluation

Marsden, Max; Vulliamy, Paul; Carden, Rich; Naumann, David N; Davenport, Ross

doi:10.1016/j.jamcollsurg.2021.04.031

Cited by 14 publications

(15 citation statements)

References 30 publications

(20 reference statements)

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“…We identified an overall hospital mortality rate of 7.1%. This is a large decrease from the near 20% rate of death following ETL from separate studies by Tang et al, 11 Harvin et al, 7 and Clarke et al, 8 but similar to the near 9% mortality rate in more recent work from the United Kingdom by Marsden 9,10,38 . Similarly, our hospital mortality rate for ETL among hypotensive patients was lower at 15% compared with more than 40% as seen in previous works.…”

Section: Discussionsupporting

confidence: 89%

“…This is a large decrease from the near 20% rate of death following ETL from separate studies by Tang et al, 11 Harvin et al, 7 and Clarke et al, 8 but similar to the near 9% mortality rate in more recent work from the United Kingdom by Marsden. 9,10,38 Similarly, our hospital mortality rate for ETL among hypotensive patients was lower at 15% compared with more than 40% as seen in previous works. Potentially, our findings may simply represent a continued evolution in improvement of care for the severely injured patient requiring ETL, especially the liberal use of blood products and restriction of crystalloid.…”

Section: Discussionsupporting

confidence: 73%

“…Subpopulations consisting of patients with an Abbreviated Injury Scale score of the abdomen (AIS-abdomen) ≥3, lactate level on arrival ≥3 mMol/L, and both AIS-abdomen ≥3 and admission lactate level ≥3 mMol/L were separately compared. 9,24,25 An additional subpopulation of patients without severe traumatic brain injury (AIS-head <3) was also compared between surgeons. Surgeons were also dichotomized, and mortality was compared among high and low volume or more and less experienced by median case number and years from training, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…The most common cause of preventable death is hemorrhage, [2][3][4][5][6] yet mortality among patients with hemorrhagic shock requiring emergent trauma laparotomy (ETL) remains above 40%, a figure that has not changed for the last 20 years. [7][8][9][10] Despite this fact, there are no standardized measures of the impact of the individual trauma surgeon related to the performance of ETL in our national reports. The ETL remains the signature procedure of traumatology and likely retains the greatest potential for the individual surgeon to impact preventable death.…”

mentioning

confidence: 99%

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It is time to look in the mirror: Individual surgeon outcomes after emergent trauma laparotomy

Jansen

Uhlich

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Multiple quality indicators are used by trauma programs to decrease variation and improve outcomes. However, little if any provider level outcomes related to surgical procedures are reviewed. Emergent trauma laparotomy (ETL) is arguably the signature case that trauma surgeons perform on a regular basis, but few data exist to facilitate benchmarking of individual surgeon outcomes. As part of our comprehensive performance improvement program, we examined outcomes by surgeon for those who routinely perform ETL. METHODS:A retrospective cohort study of patients undergoing ETL directly from the trauma bay by trauma faculty from December 2019 to February 2021 was conducted. Patients were excluded from mortality analysis if they required resuscitative thoracotomy for arrest before ETL. Surgeons were compared by rates of damage control and mortality at multiple time points. RESULTS:There were 242 ETL (7-32 ETLs per surgeon) performed by 14 faculties. Resuscitative thoracotomy was performed in 7.0% (n = 17) before ETL. Six patients without resuscitative thoracotomy died intraoperatively and damage-control laparotomy was performed on 31.9% (n = 72 of 226 patients). Mortality was 4.0% (n = 9) at 24 hours and 7.1% (n = 16) overall. Median Injury Severity Score ( p = 0.21), new injury severity score ( p = 0.21), and time in emergency department were similar overall among surgeons ( p = 0.15), while operative time varied significantly (40-469 minutes; p = 0.005). There were significant differences between rates of individual surgeon's mortality (range [hospital mortality], 0-25%) and damage-control laparotomy (range, 14-63%) in ETL. CONCLUSION:Significant differences exist in outcomes by surgeon after ETL. Benchmarking surgeon level performance is a necessary natural progression of quality assurance programs for individual trauma centers. Additional data from multiple centers will be vital to allow for development of more granular quality metrics to foster introspective case review and quality improvement.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 73%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

It is time to look in the mirror: Individual surgeon outcomes after emergent trauma laparotomy

Jansen

Uhlich

et al. 2022

J Trauma Acute Care Surg

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“…Penetrating injury is infrequent in most western European countries, whereas higher rates are seen in the US and South Africa [26,27]. In the Northern European countries, penetrating trauma is seen in 5-14% [28][29][30][31][32], and 37-58% [29,33,34] for patients undergoing trauma laparotomy, with gunshots accounting for 5-36% [28,[35][36][37][38]. In our study, penetrating trauma accounted for 16,6% of the trauma population and 66.3% for patients undergoing laparotomy.…”

Section: Discussionmentioning

confidence: 58%

A characterization of trauma laparotomies in a scandinavian setting: an observational study

Bentin

Possfelt-Møller

Svenningsen

et al. 2022

Scand J Trauma Resusc Emerg Med

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Background Despite treatment advances, trauma laparotomy continuous to be associated with significant morbidity and mortality. Most of the literature originates from high volume centers, whereas patient characteristics and outcomes in a Scandinavian setting is not well described. The objective of this study is to characterize treatments and outcomes of patients undergoing trauma laparotomy in a Scandinavian setting and compare this to international reports. Methods A retrospective study was performed in the Copenhagen University Hospital, Rigshospitalet (CUHR). All patients undergoing a trauma laparotomy within the first 24 h of admission between January 1st 2019 and December 31st 2020 were included. Collected data included demographics, trauma mechanism, injuries, procedures performed and outcomes. Results A total of 1713 trauma patients were admitted to CUHR of which 98 patients underwent trauma laparotomy. Penetrating trauma accounted for 16.6% of the trauma population and 66.3% of trauma laparotomies. Median time to surgery after arrival at the trauma center (TC) was 12 min for surgeries performed in the Emergency Department (ED) and 103 min for surgeries performed in the operating room (OR). A total of 14.3% of the procedures were performed in the ED. A damage control strategy (DCS) approach was chosen in 18.4% of cases. Our rate of negative laparotomies was 17.3%. We found a mortality rate of 8.2%. The total median length of stay was 6.1 days. Conclusion The overall rates, findings, and outcomes of trauma laparotomies in this Danish cohort is comparable to reports from similar Western European trauma systems.

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The trauma laparotomy—A key procedure that lacks global data

Bath,

Bashford

2024

World j. surg.

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Trauma accounts for approximately 9% of all global deaths, more than malaria, HIV, and tuberculosis combined. 1 It disproportionately affects individuals of working age, with concurrent high disability and mortality rates that result in wide-ranging economic impacts. Paradoxically, resource-poor areas have the highest rates of trauma but also have the worst outcomes. Consequently, there is a strong argument for optimizing trauma care in these regions, in terms of both health and economic outcomes.In managing abdominal trauma, the laparotomy remains a key procedure worldwide, providing life-saving intervention in cases where there is evidence of uncontrolled hemorrhage or a hollow viscus perforation. The laparotomy has previously been defined as a "Bellwether" procedure, as a marker of a surgical system's ability to provide safe-surgical care. 2 However, patient-level data for those undergoing a trauma laparotomy globally is currently limited. Using the trauma laparotomy as a surrogate marker for the ability of a health system to deliver trauma care provides an opportunity to better understand the need for trauma systems development worldwide.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Trauma Laparotomy in the UK: A Prospective National Service Evaluation

Cited by 14 publications

References 30 publications

It is time to look in the mirror: Individual surgeon outcomes after emergent trauma laparotomy

It is time to look in the mirror: Individual surgeon outcomes after emergent trauma laparotomy

A characterization of trauma laparotomies in a scandinavian setting: an observational study

The trauma laparotomy—A key procedure that lacks global data

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