An evaluation of emergency exploratory laparotomy timing & outcomes in adult patients with severe penetrating abdominal trauma in hemorrhagic shock.

BACKGROUND

Emergency exploratory laparotomy (ex-lap) is a commonly performed procedure in hemorrhaging trauma patients. Currently, there is a lack of consensus on ideal surgical timing, especially in conjunction with the use of whole blood and resuscitative endovascular balloon occlusion of the aorta (REBOA).

OBJECTIVE

To evaluate the impact of timing of emergency hemorrhage control exploratory laparotomy (ex-lap) on clinical outcomes in hemodynamically unstable trauma patients with penetrating abdominal injuries and hemorrhagic shock.

METHODS

This retrospective cohort analysis of adult trauma patients with penetrating abdominal injuries undergoing hemorrhage control laparotomy within 24 h of arrival used the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP-PUF) from 2017 to 2023.

RESULTS

Patients undergoing ex-lap within 2 h were 9.5 times significantly more likely to experience 24-h mortality compared to those undergoing ex-lap between 2 and 24 h (OR 9.476, 95% CI 1.276-70.397, p = 0.028). No independent association was found between WB use and in-hospital mortality (OR 1.024, 95% CI 0.716-1.465, p = 0.897). Patients who required REBOA for hemodynamic stabilization had 3.9 significantly greater odds of in-hospital mortality (OR 3.888, 95% CI 1.506-10.039, p = 0.005) and required 4498 mL significantly greater transfusion volume (95% CI 1966.115-7030.269, p < 0.001) compared to non-REBOA patients.

CONCLUSION

Emergency exploratory laparotomy within 2 h in hemodynamically unstable patients in hemorrhagic shock with moderate-severe penetrating abdominal trauma was associated with significantly higher 24-h mortality. No independent association was found between whole blood use and mortality, while REBOA was associated with significantly higher mortality and need for blood products as expected due to critical hemodynamic instability.