Current status and safety of laparoscopic surgery for patients with blunt abdominal trauma: A multicenter study using the Japan Trauma Data Bank

Abstract

AbstractIntroductionThis study was performed to examine current status and safety of laparoscopic surgery in adult patients with blunt trauma.MethodsAmong 88 817 trauma patients registered in the Japan Trauma Data Bank from January 2019 to December 2022, we included blunt trauma patients who underwent laparoscopic surgery and/or laparotomy. We excluded patients with non‐blunt trauma, systolic blood pressure (sBP) of 0 mmHg on admission, age of <15 years, and Injury Severity Score (ISS) of 75. First, patients were divided into two groups: he laparoscopic surgery group (including patients transitioned from laparoscopic surgery) and the laparotomy‐only group. Second, missing values were estimated by multiple imputation. Finally, in‐hospital mortality was analyzed using propensity score matching to balance patient characteristics (age, sex, sBP, Glasgow coma scale (GCS) score, abdominal Abbreviated Injury Scale score, and ISS).ResultsWe analyzed 1301 patients [68 (5.2%) in the laparoscopic surgery group and 1233 (94.8%) in the laparotomy‐only group]. After propensity score matching, the in‐hospital mortality rate was 1.5% in the laparoscopy group and 10.0% in the laparotomy‐only group (p < .03). The odds ratio of in‐hospital mortality for the laparotomy‐only group after propensity score matching was 4.06 (95% confidence interval, 0.30–54.9; p = .29) compared with the laparoscopy group. After propensity score matching, there were no deaths occurred with patients of intra‐abdominal hemorrhage. In‐hospital mortality was not significantly different with peritonitis patients (p = .36).ConclusionsLaparoscopic surgical intervention was safely performed for selected adult patients with blunt abdominal trauma without an increase in mortality.