Mortality Following Emergent Trauma Laparotomy: a Multicenter, Retrospective Study: Mortality after Emergent Trauma Laparotomy

John A. Harvin, Tom Maxim, Kenji Inaba, Myriam A. Martinez-Aguilar, David R. King, Asad J. Choudhry, Martin D. Zielinski, Sam Akinyeye, Rob R. Todd, Russell L. Griffin, Jeffrey D. Kerby, Joanelle A. Bailey, David H. Livingston, Kyle Cunningham, Deborah M. Stein, Lindsay Cattin, Eileen M. Bulger, A. Wilson, Vicente J. Undurraga Perl, Martin SchreiberJill R. Cherry-Bukowiec, Hasan B. Alam, John B. Holcomb

    Research output: Contribution to journalArticle

    25 Citations (Scopus)

    Abstract

    BACKGROUND: Two decades ago, hypotensive trauma patients requiring emergent laparotomy had a 40% mortality. In the interim, multiple interventions to decrease hemorrhage-related mortality have been implemented but few have any documented evidence of change in outcomes for patients requiring emergent laparotomy. The purpose of this study was to determine current mortality rates for patients undergoing emergent trauma laparotomy. METHODS: A retrospective cohort of all adult, emergent trauma laparotomies performed in 2012-2013 at 12 Level I trauma centers was reviewed. Emergent trauma laparotomy was defined as emergency department (ED) admission to surgical start time in ≤90 minutes. Hypotension was defined as arrival ED systolic blood pressure (SBP) ≤90 mmHg. Cause and time to death was also determined. Continuous data are presented as median [IQR]. RESULTS: 1,706 patients underwent emergent trauma laparotomy. The cohort was predominately young (31 years [24, 45]), male (84%), sustained blunt trauma (67%), and with moderate injuries (ISS 19 [10, 33]). The time in ED was 24 minutes [14, 39] and time from ED admission to surgical start was 42 minutes [30, 61]. The most common procedures were enterectomy (23%), hepatorrhaphy (20%), enterorrhaphy (16%), and splenectomy (16%). Damage control laparotomy was utilized in 38% of all patients and 62% of hypotensive patients. The Injury Severity Score for the entire cohort was 19 (IQR 10, 33) and 29 (IQR 18, 41) for the hypotensive group. Mortality for the entire cohort was 21% with 60% of deaths due to hemorrhage. Mortality in the hypotensive group was 46%, with 65% of deaths due to hemorrhage. CONCLUSION: Overall mortality rate of a trauma laparotomy is substantial (21%) with hemorrhage accounting for 60% of the deaths. The mortality rate for hypotensive patients (46%) appears unchanged over the last two decades and is even more concerning, with almost half of patients presenting with a SBP ≤ 90 mmHg dying. LEVEL OF EVIDENCE: Level III (retrospective epidemiologcal study with up to two negative criteria)

    Original languageEnglish (US)
    JournalJournal of Trauma and Acute Care Surgery
    DOIs
    StateAccepted/In press - Jun 9 2017

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    Laparotomy
    Multicenter Studies
    Retrospective Studies
    Mortality
    Wounds and Injuries
    Hospital Emergency Service
    Hemorrhage
    Blood Pressure
    Injury Severity Score
    Trauma Centers
    Splenectomy
    Hypotension

    ASJC Scopus subject areas

    • Surgery
    • Critical Care and Intensive Care Medicine

    Cite this

    Mortality Following Emergent Trauma Laparotomy : a Multicenter, Retrospective Study: Mortality after Emergent Trauma Laparotomy. / Harvin, John A.; Maxim, Tom; Inaba, Kenji; Martinez-Aguilar, Myriam A.; King, David R.; Choudhry, Asad J.; Zielinski, Martin D.; Akinyeye, Sam; Todd, Rob R.; Griffin, Russell L.; Kerby, Jeffrey D.; Bailey, Joanelle A.; Livingston, David H.; Cunningham, Kyle; Stein, Deborah M.; Cattin, Lindsay; Bulger, Eileen M.; Wilson, A.; Undurraga Perl, Vicente J.; Schreiber, Martin; Cherry-Bukowiec, Jill R.; Alam, Hasan B.; Holcomb, John B.

    In: Journal of Trauma and Acute Care Surgery, 09.06.2017.

    Research output: Contribution to journalArticle

    Harvin, JA, Maxim, T, Inaba, K, Martinez-Aguilar, MA, King, DR, Choudhry, AJ, Zielinski, MD, Akinyeye, S, Todd, RR, Griffin, RL, Kerby, JD, Bailey, JA, Livingston, DH, Cunningham, K, Stein, DM, Cattin, L, Bulger, EM, Wilson, A, Undurraga Perl, VJ, Schreiber, M, Cherry-Bukowiec, JR, Alam, HB & Holcomb, JB 2017, 'Mortality Following Emergent Trauma Laparotomy: a Multicenter, Retrospective Study: Mortality after Emergent Trauma Laparotomy', Journal of Trauma and Acute Care Surgery. https://doi.org/10.1097/TA.0000000000001619
    Harvin, John A. ; Maxim, Tom ; Inaba, Kenji ; Martinez-Aguilar, Myriam A. ; King, David R. ; Choudhry, Asad J. ; Zielinski, Martin D. ; Akinyeye, Sam ; Todd, Rob R. ; Griffin, Russell L. ; Kerby, Jeffrey D. ; Bailey, Joanelle A. ; Livingston, David H. ; Cunningham, Kyle ; Stein, Deborah M. ; Cattin, Lindsay ; Bulger, Eileen M. ; Wilson, A. ; Undurraga Perl, Vicente J. ; Schreiber, Martin ; Cherry-Bukowiec, Jill R. ; Alam, Hasan B. ; Holcomb, John B. / Mortality Following Emergent Trauma Laparotomy : a Multicenter, Retrospective Study: Mortality after Emergent Trauma Laparotomy. In: Journal of Trauma and Acute Care Surgery. 2017.
    @article{70d02e1da0614b528066281e88d4d5e0,
    title = "Mortality Following Emergent Trauma Laparotomy: a Multicenter, Retrospective Study: Mortality after Emergent Trauma Laparotomy",
    abstract = "BACKGROUND: Two decades ago, hypotensive trauma patients requiring emergent laparotomy had a 40{\%} mortality. In the interim, multiple interventions to decrease hemorrhage-related mortality have been implemented but few have any documented evidence of change in outcomes for patients requiring emergent laparotomy. The purpose of this study was to determine current mortality rates for patients undergoing emergent trauma laparotomy. METHODS: A retrospective cohort of all adult, emergent trauma laparotomies performed in 2012-2013 at 12 Level I trauma centers was reviewed. Emergent trauma laparotomy was defined as emergency department (ED) admission to surgical start time in ≤90 minutes. Hypotension was defined as arrival ED systolic blood pressure (SBP) ≤90 mmHg. Cause and time to death was also determined. Continuous data are presented as median [IQR]. RESULTS: 1,706 patients underwent emergent trauma laparotomy. The cohort was predominately young (31 years [24, 45]), male (84{\%}), sustained blunt trauma (67{\%}), and with moderate injuries (ISS 19 [10, 33]). The time in ED was 24 minutes [14, 39] and time from ED admission to surgical start was 42 minutes [30, 61]. The most common procedures were enterectomy (23{\%}), hepatorrhaphy (20{\%}), enterorrhaphy (16{\%}), and splenectomy (16{\%}). Damage control laparotomy was utilized in 38{\%} of all patients and 62{\%} of hypotensive patients. The Injury Severity Score for the entire cohort was 19 (IQR 10, 33) and 29 (IQR 18, 41) for the hypotensive group. Mortality for the entire cohort was 21{\%} with 60{\%} of deaths due to hemorrhage. Mortality in the hypotensive group was 46{\%}, with 65{\%} of deaths due to hemorrhage. CONCLUSION: Overall mortality rate of a trauma laparotomy is substantial (21{\%}) with hemorrhage accounting for 60{\%} of the deaths. The mortality rate for hypotensive patients (46{\%}) appears unchanged over the last two decades and is even more concerning, with almost half of patients presenting with a SBP ≤ 90 mmHg dying. LEVEL OF EVIDENCE: Level III (retrospective epidemiologcal study with up to two negative criteria)",
    author = "Harvin, {John A.} and Tom Maxim and Kenji Inaba and Martinez-Aguilar, {Myriam A.} and King, {David R.} and Choudhry, {Asad J.} and Zielinski, {Martin D.} and Sam Akinyeye and Todd, {Rob R.} and Griffin, {Russell L.} and Kerby, {Jeffrey D.} and Bailey, {Joanelle A.} and Livingston, {David H.} and Kyle Cunningham and Stein, {Deborah M.} and Lindsay Cattin and Bulger, {Eileen M.} and A. Wilson and {Undurraga Perl}, {Vicente J.} and Martin Schreiber and Cherry-Bukowiec, {Jill R.} and Alam, {Hasan B.} and Holcomb, {John B.}",
    year = "2017",
    month = "6",
    day = "9",
    doi = "10.1097/TA.0000000000001619",
    language = "English (US)",
    journal = "Journal of Trauma and Acute Care Surgery",
    issn = "2163-0755",
    publisher = "Lippincott Williams and Wilkins",

    }

    TY - JOUR

    T1 - Mortality Following Emergent Trauma Laparotomy

    T2 - a Multicenter, Retrospective Study: Mortality after Emergent Trauma Laparotomy

    AU - Harvin, John A.

    AU - Maxim, Tom

    AU - Inaba, Kenji

    AU - Martinez-Aguilar, Myriam A.

    AU - King, David R.

    AU - Choudhry, Asad J.

    AU - Zielinski, Martin D.

    AU - Akinyeye, Sam

    AU - Todd, Rob R.

    AU - Griffin, Russell L.

    AU - Kerby, Jeffrey D.

    AU - Bailey, Joanelle A.

    AU - Livingston, David H.

    AU - Cunningham, Kyle

    AU - Stein, Deborah M.

    AU - Cattin, Lindsay

    AU - Bulger, Eileen M.

    AU - Wilson, A.

    AU - Undurraga Perl, Vicente J.

    AU - Schreiber, Martin

    AU - Cherry-Bukowiec, Jill R.

    AU - Alam, Hasan B.

    AU - Holcomb, John B.

    PY - 2017/6/9

    Y1 - 2017/6/9

    N2 - BACKGROUND: Two decades ago, hypotensive trauma patients requiring emergent laparotomy had a 40% mortality. In the interim, multiple interventions to decrease hemorrhage-related mortality have been implemented but few have any documented evidence of change in outcomes for patients requiring emergent laparotomy. The purpose of this study was to determine current mortality rates for patients undergoing emergent trauma laparotomy. METHODS: A retrospective cohort of all adult, emergent trauma laparotomies performed in 2012-2013 at 12 Level I trauma centers was reviewed. Emergent trauma laparotomy was defined as emergency department (ED) admission to surgical start time in ≤90 minutes. Hypotension was defined as arrival ED systolic blood pressure (SBP) ≤90 mmHg. Cause and time to death was also determined. Continuous data are presented as median [IQR]. RESULTS: 1,706 patients underwent emergent trauma laparotomy. The cohort was predominately young (31 years [24, 45]), male (84%), sustained blunt trauma (67%), and with moderate injuries (ISS 19 [10, 33]). The time in ED was 24 minutes [14, 39] and time from ED admission to surgical start was 42 minutes [30, 61]. The most common procedures were enterectomy (23%), hepatorrhaphy (20%), enterorrhaphy (16%), and splenectomy (16%). Damage control laparotomy was utilized in 38% of all patients and 62% of hypotensive patients. The Injury Severity Score for the entire cohort was 19 (IQR 10, 33) and 29 (IQR 18, 41) for the hypotensive group. Mortality for the entire cohort was 21% with 60% of deaths due to hemorrhage. Mortality in the hypotensive group was 46%, with 65% of deaths due to hemorrhage. CONCLUSION: Overall mortality rate of a trauma laparotomy is substantial (21%) with hemorrhage accounting for 60% of the deaths. The mortality rate for hypotensive patients (46%) appears unchanged over the last two decades and is even more concerning, with almost half of patients presenting with a SBP ≤ 90 mmHg dying. LEVEL OF EVIDENCE: Level III (retrospective epidemiologcal study with up to two negative criteria)

    AB - BACKGROUND: Two decades ago, hypotensive trauma patients requiring emergent laparotomy had a 40% mortality. In the interim, multiple interventions to decrease hemorrhage-related mortality have been implemented but few have any documented evidence of change in outcomes for patients requiring emergent laparotomy. The purpose of this study was to determine current mortality rates for patients undergoing emergent trauma laparotomy. METHODS: A retrospective cohort of all adult, emergent trauma laparotomies performed in 2012-2013 at 12 Level I trauma centers was reviewed. Emergent trauma laparotomy was defined as emergency department (ED) admission to surgical start time in ≤90 minutes. Hypotension was defined as arrival ED systolic blood pressure (SBP) ≤90 mmHg. Cause and time to death was also determined. Continuous data are presented as median [IQR]. RESULTS: 1,706 patients underwent emergent trauma laparotomy. The cohort was predominately young (31 years [24, 45]), male (84%), sustained blunt trauma (67%), and with moderate injuries (ISS 19 [10, 33]). The time in ED was 24 minutes [14, 39] and time from ED admission to surgical start was 42 minutes [30, 61]. The most common procedures were enterectomy (23%), hepatorrhaphy (20%), enterorrhaphy (16%), and splenectomy (16%). Damage control laparotomy was utilized in 38% of all patients and 62% of hypotensive patients. The Injury Severity Score for the entire cohort was 19 (IQR 10, 33) and 29 (IQR 18, 41) for the hypotensive group. Mortality for the entire cohort was 21% with 60% of deaths due to hemorrhage. Mortality in the hypotensive group was 46%, with 65% of deaths due to hemorrhage. CONCLUSION: Overall mortality rate of a trauma laparotomy is substantial (21%) with hemorrhage accounting for 60% of the deaths. The mortality rate for hypotensive patients (46%) appears unchanged over the last two decades and is even more concerning, with almost half of patients presenting with a SBP ≤ 90 mmHg dying. LEVEL OF EVIDENCE: Level III (retrospective epidemiologcal study with up to two negative criteria)

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    DO - 10.1097/TA.0000000000001619

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