Diagnostic Laparoscopy in Trauma Patients: Do We Need to Open and See if We Can See Without Opening?
Diagnostic laparoscopy (DL) has been advocated to reduce the incidence of nontherapeutic laparotomies (NL) among stable trauma patients. This study aimed to compare the outcomes of hemodynamically stable trauma patients undergoing DL versus NL. This is a retrospective analysis of the American Colleg...
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| Veröffentlicht in: | The Journal of surgical research 2024-11, Vol.303, p.14-21 |
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| creator | Hage, Kati Nelson, Adam Khurshid, Muhammad Haris Stewart, Collin Hosseinpour, Hamidreza Okosun, Stanley Hejazi, Omar Magnotti, Louis J. Bhogadi, Sai Krishna Joseph, Bellal |
| description | Diagnostic laparoscopy (DL) has been advocated to reduce the incidence of nontherapeutic laparotomies (NL) among stable trauma patients. This study aimed to compare the outcomes of hemodynamically stable trauma patients undergoing DL versus NL.
This is a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database over 4 y (2017-2020). Hemodynamically stable (systolic blood pressure >90 & heart rate |
| doi_str_mv | 10.1016/j.jss.2024.08.014 |
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This is a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database over 4 y (2017-2020). Hemodynamically stable (systolic blood pressure >90 & heart rate < 120) adult (≥18 y) trauma patients undergoing DL or NL were included. Patients were stratified into DL and NL and substratified based on the mechanism of injury (blunt versus penetrating) and compared.
Over 4 y, 3801 patients were identified, of which, 997 (26.2%) underwent DL. Overall, 25.6% sustained blunt injuries. The mean (SD) age was 39 (16) and 79.5% were male. The median injury severity score and abdominal abbreviated injury scale were 4 [4-9] and 1 [1-2], with no difference among study groups (P ≥ 0.05). The overall mortality and major complication rates were 2.8% and 13.2%, respectively. After controlling for potential confounding factors, DL was independently associated with lower odds of mortality (adjusted odds ratio: 0.10, 95% CI [0.04-0.29], P < 0.001) and major complications (adjusted odds ratio: 0.38, 95% CI [0.29-0.50], P < 0.001) and shorter hospital length of stay (β: −1.22, 95% CI [-1.78 to −0.67], P < 0.001). The trends toward improved outcomes in the DL group remained the same in the subanalysis of patients with penetrating and blunt injuries.
With advances in minimally invasive surgery, unnecessary exploratory laparotomy can be avoided in many trauma patients. Our study shows that hemodynamically stable patients undergoing DL had superior outcomes compared to those with NL.</description><identifier>ISSN: 0022-4804</identifier><identifier>ISSN: 1095-8673</identifier><identifier>EISSN: 1095-8673</identifier><identifier>DOI: 10.1016/j.jss.2024.08.014</identifier><identifier>PMID: 39288515</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abdominal Injuries - diagnosis ; Abdominal Injuries - mortality ; Abdominal Injuries - surgery ; Adult ; Blunt and penetrating injuries ; Complications ; Diagnostic laparoscopy ; Female ; Humans ; Injury Severity Score ; Laparoscopy - statistics & numerical data ; Laparotomy ; Length of Stay - statistics & numerical data ; Male ; Middle Aged ; Mortality ; Non-therapeutic laparotomy ; Postoperative Complications - diagnosis ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - prevention & control ; Retrospective Studies ; Trauma ; Wounds, Nonpenetrating - diagnosis ; Wounds, Nonpenetrating - mortality ; Wounds, Nonpenetrating - surgery ; Wounds, Penetrating - diagnosis ; Wounds, Penetrating - mortality ; Wounds, Penetrating - surgery ; Young Adult</subject><ispartof>The Journal of surgical research, 2024-11, Vol.303, p.14-21</ispartof><rights>2024 Elsevier Inc.</rights><rights>Copyright © 2024 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c235t-b8409960c925883393d5eb8cce2d00ad056d47d6f91fc1b1a11181e3164f72a3</cites><orcidid>0000-0002-2205-3061</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jss.2024.08.014$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39288515$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hage, Kati</creatorcontrib><creatorcontrib>Nelson, Adam</creatorcontrib><creatorcontrib>Khurshid, Muhammad Haris</creatorcontrib><creatorcontrib>Stewart, Collin</creatorcontrib><creatorcontrib>Hosseinpour, Hamidreza</creatorcontrib><creatorcontrib>Okosun, Stanley</creatorcontrib><creatorcontrib>Hejazi, Omar</creatorcontrib><creatorcontrib>Magnotti, Louis J.</creatorcontrib><creatorcontrib>Bhogadi, Sai Krishna</creatorcontrib><creatorcontrib>Joseph, Bellal</creatorcontrib><title>Diagnostic Laparoscopy in Trauma Patients: Do We Need to Open and See if We Can See Without Opening?</title><title>The Journal of surgical research</title><addtitle>J Surg Res</addtitle><description>Diagnostic laparoscopy (DL) has been advocated to reduce the incidence of nontherapeutic laparotomies (NL) among stable trauma patients. This study aimed to compare the outcomes of hemodynamically stable trauma patients undergoing DL versus NL.
This is a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database over 4 y (2017-2020). Hemodynamically stable (systolic blood pressure >90 & heart rate < 120) adult (≥18 y) trauma patients undergoing DL or NL were included. Patients were stratified into DL and NL and substratified based on the mechanism of injury (blunt versus penetrating) and compared.
Over 4 y, 3801 patients were identified, of which, 997 (26.2%) underwent DL. Overall, 25.6% sustained blunt injuries. The mean (SD) age was 39 (16) and 79.5% were male. The median injury severity score and abdominal abbreviated injury scale were 4 [4-9] and 1 [1-2], with no difference among study groups (P ≥ 0.05). The overall mortality and major complication rates were 2.8% and 13.2%, respectively. After controlling for potential confounding factors, DL was independently associated with lower odds of mortality (adjusted odds ratio: 0.10, 95% CI [0.04-0.29], P < 0.001) and major complications (adjusted odds ratio: 0.38, 95% CI [0.29-0.50], P < 0.001) and shorter hospital length of stay (β: −1.22, 95% CI [-1.78 to −0.67], P < 0.001). The trends toward improved outcomes in the DL group remained the same in the subanalysis of patients with penetrating and blunt injuries.
With advances in minimally invasive surgery, unnecessary exploratory laparotomy can be avoided in many trauma patients. Our study shows that hemodynamically stable patients undergoing DL had superior outcomes compared to those with NL.</description><subject>Abdominal Injuries - diagnosis</subject><subject>Abdominal Injuries - mortality</subject><subject>Abdominal Injuries - surgery</subject><subject>Adult</subject><subject>Blunt and penetrating injuries</subject><subject>Complications</subject><subject>Diagnostic laparoscopy</subject><subject>Female</subject><subject>Humans</subject><subject>Injury Severity Score</subject><subject>Laparoscopy - statistics & numerical data</subject><subject>Laparotomy</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Non-therapeutic laparotomy</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Retrospective Studies</subject><subject>Trauma</subject><subject>Wounds, Nonpenetrating - diagnosis</subject><subject>Wounds, Nonpenetrating - mortality</subject><subject>Wounds, Nonpenetrating - surgery</subject><subject>Wounds, Penetrating - diagnosis</subject><subject>Wounds, Penetrating - mortality</subject><subject>Wounds, Penetrating - surgery</subject><subject>Young Adult</subject><issn>0022-4804</issn><issn>1095-8673</issn><issn>1095-8673</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMFO3DAQhi1EVba0D8Cl8pFL0hk7yTpwQNXSlkorQOpKHC2vPaFe7cZp7FTi7etlKUdOo9F8_y_Nx9gZQomAzZdNuYmxFCCqElQJWB2xGUJbF6qZy2M2AxCiqBRUJ-xDjBvIezuX79mJbIVSNdYz5q69eexDTN7ypRnMGKINwxP3PV-NZtoZfm-Spz7FC34d-APxWyLHU-B3A_Xc9I7_IuK-258Wpn_eHnz6Hab0jPj-8eoje9eZbaRPL_OUrb5_Wy1uiuXdj5-Lr8vCClmnYq0qaNsGbCtqpaRspatprawl4QCMg7px1dw1XYudxTUaRFRIEpuqmwsjT9n5oXYYw5-JYtI7Hy1tt6anMEUtEZqqAakwo3hAbX44jtTpYfQ7Mz5pBL13qzc6u9V7txqUzm5z5vNL_bTekXtN_JeZgcsDQPnHv55GHW1WZ8n5kWzSLvg36v8BCkiH0Q</recordid><startdate>202411</startdate><enddate>202411</enddate><creator>Hage, Kati</creator><creator>Nelson, Adam</creator><creator>Khurshid, Muhammad Haris</creator><creator>Stewart, Collin</creator><creator>Hosseinpour, Hamidreza</creator><creator>Okosun, Stanley</creator><creator>Hejazi, Omar</creator><creator>Magnotti, Louis J.</creator><creator>Bhogadi, Sai Krishna</creator><creator>Joseph, Bellal</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2205-3061</orcidid></search><sort><creationdate>202411</creationdate><title>Diagnostic Laparoscopy in Trauma Patients: Do We Need to Open and See if We Can See Without Opening?</title><author>Hage, Kati ; Nelson, Adam ; Khurshid, Muhammad Haris ; Stewart, Collin ; Hosseinpour, Hamidreza ; Okosun, Stanley ; Hejazi, Omar ; Magnotti, Louis J. ; Bhogadi, Sai Krishna ; Joseph, Bellal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c235t-b8409960c925883393d5eb8cce2d00ad056d47d6f91fc1b1a11181e3164f72a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Abdominal Injuries - diagnosis</topic><topic>Abdominal Injuries - mortality</topic><topic>Abdominal Injuries - surgery</topic><topic>Adult</topic><topic>Blunt and penetrating injuries</topic><topic>Complications</topic><topic>Diagnostic laparoscopy</topic><topic>Female</topic><topic>Humans</topic><topic>Injury Severity Score</topic><topic>Laparoscopy - statistics & numerical data</topic><topic>Laparotomy</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Non-therapeutic laparotomy</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Retrospective Studies</topic><topic>Trauma</topic><topic>Wounds, Nonpenetrating - diagnosis</topic><topic>Wounds, Nonpenetrating - mortality</topic><topic>Wounds, Nonpenetrating - surgery</topic><topic>Wounds, Penetrating - diagnosis</topic><topic>Wounds, Penetrating - mortality</topic><topic>Wounds, Penetrating - surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hage, Kati</creatorcontrib><creatorcontrib>Nelson, Adam</creatorcontrib><creatorcontrib>Khurshid, Muhammad Haris</creatorcontrib><creatorcontrib>Stewart, Collin</creatorcontrib><creatorcontrib>Hosseinpour, Hamidreza</creatorcontrib><creatorcontrib>Okosun, Stanley</creatorcontrib><creatorcontrib>Hejazi, Omar</creatorcontrib><creatorcontrib>Magnotti, Louis J.</creatorcontrib><creatorcontrib>Bhogadi, Sai Krishna</creatorcontrib><creatorcontrib>Joseph, Bellal</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of surgical research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hage, Kati</au><au>Nelson, Adam</au><au>Khurshid, Muhammad Haris</au><au>Stewart, Collin</au><au>Hosseinpour, Hamidreza</au><au>Okosun, Stanley</au><au>Hejazi, Omar</au><au>Magnotti, Louis J.</au><au>Bhogadi, Sai Krishna</au><au>Joseph, Bellal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic Laparoscopy in Trauma Patients: Do We Need to Open and See if We Can See Without Opening?</atitle><jtitle>The Journal of surgical research</jtitle><addtitle>J Surg Res</addtitle><date>2024-11</date><risdate>2024</risdate><volume>303</volume><spage>14</spage><epage>21</epage><pages>14-21</pages><issn>0022-4804</issn><issn>1095-8673</issn><eissn>1095-8673</eissn><abstract>Diagnostic laparoscopy (DL) has been advocated to reduce the incidence of nontherapeutic laparotomies (NL) among stable trauma patients. This study aimed to compare the outcomes of hemodynamically stable trauma patients undergoing DL versus NL.
This is a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database over 4 y (2017-2020). Hemodynamically stable (systolic blood pressure >90 & heart rate < 120) adult (≥18 y) trauma patients undergoing DL or NL were included. Patients were stratified into DL and NL and substratified based on the mechanism of injury (blunt versus penetrating) and compared.
Over 4 y, 3801 patients were identified, of which, 997 (26.2%) underwent DL. Overall, 25.6% sustained blunt injuries. The mean (SD) age was 39 (16) and 79.5% were male. The median injury severity score and abdominal abbreviated injury scale were 4 [4-9] and 1 [1-2], with no difference among study groups (P ≥ 0.05). The overall mortality and major complication rates were 2.8% and 13.2%, respectively. After controlling for potential confounding factors, DL was independently associated with lower odds of mortality (adjusted odds ratio: 0.10, 95% CI [0.04-0.29], P < 0.001) and major complications (adjusted odds ratio: 0.38, 95% CI [0.29-0.50], P < 0.001) and shorter hospital length of stay (β: −1.22, 95% CI [-1.78 to −0.67], P < 0.001). The trends toward improved outcomes in the DL group remained the same in the subanalysis of patients with penetrating and blunt injuries.
With advances in minimally invasive surgery, unnecessary exploratory laparotomy can be avoided in many trauma patients. Our study shows that hemodynamically stable patients undergoing DL had superior outcomes compared to those with NL.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>39288515</pmid><doi>10.1016/j.jss.2024.08.014</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2205-3061</orcidid></addata></record> |
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| subjects | Abdominal Injuries - diagnosis Abdominal Injuries - mortality Abdominal Injuries - surgery Adult Blunt and penetrating injuries Complications Diagnostic laparoscopy Female Humans Injury Severity Score Laparoscopy - statistics & numerical data Laparotomy Length of Stay - statistics & numerical data Male Middle Aged Mortality Non-therapeutic laparotomy Postoperative Complications - diagnosis Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - prevention & control Retrospective Studies Trauma Wounds, Nonpenetrating - diagnosis Wounds, Nonpenetrating - mortality Wounds, Nonpenetrating - surgery Wounds, Penetrating - diagnosis Wounds, Penetrating - mortality Wounds, Penetrating - surgery Young Adult |
| title | Diagnostic Laparoscopy in Trauma Patients: Do We Need to Open and See if We Can See Without Opening? |
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