Abstract
BackgroundFar reaching sub-specialization tends to become obligatory for surgeons in most Western countries. It is suggested that exposure of surgeons to emergency laparotomy after trauma is ever declining. Therefore, it can be questioned whether a generalist (i.e., general surgery) with additional differentiation such as the trauma surgeon, will still be needed and can remain sufficiently qualified. This study aimed to evaluate volume trends and outcomes of emergency laparotomies in trauma.MethodsA retrospective cohort study was performed in the University Medical Center Utrecht between January 2008 and January 2018, in which all patients who underwent an emergency laparotomy for trauma were included. Collected data were demographics, trauma-related characteristics, and number of (planned and unplanned) laparotomies with their indications. Primary outcome was in-hospital mortality; secondary outcomes were complications, length of ICU, and overall hospital stay.ResultsA total of 268 index emergency laparotomies were evaluated. Total number of patients who presented with an abdominal AIS > 2 remained constant over the past 10 years, as did the percentage of patients that required an emergency laparotomy. Most were polytrauma patients with a mean ISS = 27.5 (SD ± 14.9). The most frequent indication for laparotomy was hemodynamic instability or ongoing blood loss (44%).Unplanned relaparotomies occurred in 21% of the patients, mostly due to relapse of bleeding. Other complications were anastomotic leakage (8.6%), intestinal leakage after bowel contusion (4%). In addition, an incisional hernia was found in 6.3%. Mortality rate was 16.7%, mostly due to neurologic origin (42%). Average length of stay was 16 days with an ICU stay of 5 days.ConclusionThis study shows a persistent number of patients requiring emergency laparotomy after (blunt) abdominal trauma over 10 years in a European trauma center. When performed by a dedicated trauma team, this results in acceptable mortality and complication rates in this severely injured population.
Highlights
Far reaching sub-specialization tends to become obligatory for surgeons in most Western countries
The reluctance of far-reaching centralization in trauma in combination with work hour regulations restrict exposure for surgeons in the European Union for this procedure [9]. It can be questioned if the knowledge and skillset required to perform such an emergency laparotomy in severely injured patients can be maintained [10]. These developments might challenge the competence of the surgeons who deal with trauma patients with regard to an emergency laparotomy and, as a result, outcome of severely injured patients [11]
The aim of this study was to evaluate the outcome after an emergency laparotomy in trauma patients, performed in a Dutch level 1 trauma center
Summary
Far reaching sub-specialization tends to become obligatory for surgeons in most Western countries. It is suggested that the exposure of most European surgeons to an emergency laparotomy in severely injured patients is declining [1]. In an era of ongoing sub-specialization, trauma surgery still requires a broad perspective and diverse skill set in order to provide adequate care for the most severely injured patients [5]. The reluctance of far-reaching centralization in trauma in combination with work hour regulations restrict exposure for surgeons in the European Union for this procedure [9]. It can be questioned if the knowledge and skillset required to perform such an emergency laparotomy in severely injured patients can be maintained [10]. These developments might challenge the competence of the surgeons who deal with trauma patients with regard to an emergency laparotomy and, as a result, outcome of severely injured patients [11]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
