Nationwide analysis of minimally invasive surgical approach in patients with penetrating abdominal trauma.

INTRODUCTION

Exploratory laparotomy has been the main method for surgical interventions in penetrating abdominal trauma (PAT). Minimally invasive surgery (MIS) has been utilized in the treatment of selected trauma patients as an alternative to laparotomy. This study aimed to investigate the utilization of MIS and open approaches in patients with PAT.

METHODS

Patients who underwent surgical treatment for PAT were included in this study using the National Inpatient Sample 2016-2020. Patients who underwent diagnostic laparoscopy or other laparoscopic or robotic procedures during admission were categorized as MIS.

RESULTS

A total of 94,280 patients with PAT were analyzed (open: 82,745 (87.8%), MIS: 8,630 (9.2%), and conversion to open: 2,905 (3.1%)). The trend of using a MIS approach remained stable between 2016 and 2020 (8.6-9.7%). Independent predictors of using MIS were younger age, female gender, higher median income of residence area, and urban nonteaching hospitals. Independent factors associated with less MIS intervention were Midwest and South locations, Black race, firearm mechanism, and a higher Charlson Comorbidity Index score or Injury Severity Score. MIS approach had significantly lower hospitalization cost median and interquartile range ($16,822 [11,764-26,489] vs $32,913 [20,270-63,016]) and shorter length of stay (4 [2-7] vs 8 [5-14] days) compared to open approach. The complication rate was lower in the MIS group.

CONCLUSION

The MIS approach is utilized in a subgroup of patients with PAT with acceptable outcomes, shorter length of stay, and reduced costs. Further research is needed to develop strategies to increase the utilization of MIS in the management of patients with trauma.