Occult Hypoperfusion Is Common among Adult Patients Undergoing Emergency Trauma Laparotomy and Is Associated with Worsened Postoperative Outcomes in Elderly Patients

Abstract

INTRODUCTION: Occult hypoperfusion (OH), defined as global hypoperfusion with normal vital signs, is often underrecognized in elderly trauma patients and may lead to worse outcomes. We hypothesized that elderly patients with OH who undergo emergency trauma laparotomy have worse postoperative outcomes than those with overt shock. METHODS: A retrospective cohort study of adult patients undergoing emergency trauma laparotomy from January 2011 to September 2019 was performed. Patients were stratified by age (young, less than 55 years, or elderly, older than 55 years) and arrival perfusion status with shock defined as systolic blood pressure less than 90 mmHg or heart rate greater than 120 bpm, OH as heart rate 120 bpm or less and systolic blood pressure 90 mmHg or greater and BE <-2 mmol/L, and others as normal. The primary outcome was major abdominal complication (MAC), a composite of organ/space surgical-site infection, fascial dehiscence, anastomotic leak, enteroatmospheric/enterocutaneous fistula, or reopening of laparotomy after fascial closure. Bayesian logistic regression was performed, controlling for Injury Severity Score, mechanism, and damage control laparotomy. RESULTS: Of 1,570 patients, the majority were male (78%), had blunt injury (53%), median age of 33 years (interquartile range 23 to 46), and were severely injured (median Injury Severity Score 19, interquartile range 10 to 29). Of the 14% elderly patients, 27% had OH on arrival. Elderly patients with arrival OH or shock had greater odds of MAC than patients with normal perfusion. There was an 87% probability that elderly patients with OH had greater odds of MAC than those with arrival shock (Figure).Figure.: MAC, major abdominal complication; OH, occult hypoperfusion.CONCLUSION: Elderly patients with OH experienced increased odds of MAC compared with those with overt shock or normal perfusion. Attention should be paid to identifying and treating OH in elderly trauma patients.