Assessment of Outcomes in Laparotomy vs Laparoscopy: A Propensity Score Matched Analysis of Patients Sustaining Single Penetrating Left Upper Quadrant Injury.

Abstract

We aim to compare outcomes between laparotomy and laparoscopy in trauma patients with single penetrating left upper quadrant injuries. Using a 1:1 propensity score match, a retrospective study was conducted utilizing data from the ACS-TQP-PUF between 2016 and 2019. Adults sustaining a single penetrating left upper quadrant injury who received either a laparotomy or laparoscopy were included for analysis. The primary outcome was inpatient mortality. Secondary outcomes included ICU-LOS, H-LOS, and complication rates. Multivariable regression and reliability adjustments were performed to control for confounding. 486 patients receiving laparotomy were matched to 486 patients receiving laparoscopy. No differences in inpatient mortality (1.2% vs 2.9%, aOR: 2.92, 95% CI: .32, 26.31); however, patients undergoing laparotomy experienced higher complication rates (7.0% vs 1.2%, aOR: 9.61, 95% CI: 1.94, 47.48), pRBC transfusions (21.8% vs 6.4%, aOR: 3.19, 95% CI: 1.66, 6.13), and H-LOS (Mean ± SD: 8.1 ± 9.8 vs 3.9 ± 4.0, P = .0002). Lower ISS (1 - 15) undergoing laparotomy had more complications (4.3% vs .7%, aOR: 13.52, 95% CI: 1.39, 131.69), pRBC transfusions (13.9% vs 4.9%, aOR: 3.21, 95% CI: 1.53, 6.75), and H-LOS (Mean ± SD: 6.7 ± 7.1 vs 3.6 ± 3.2, P < .0001). There were no differences in mortality among patients with a lower ISS (1.5% vs .4%, aOR: 77.2, 95% CI: (<.001, >999). Laparotomy is associated with increased rates of complications for single penetrating LUQ trauma. For patients with low ISS, laparoscopy is associated with better outcomes without increase in mortality.