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Bedside laparotomy for trauma: are there risks?

Jose J Diaz1, Adele Mauer, Addison K May

  • 1Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA. jose.diaz@vanderbilt.edu

Surgical Infections
|May 15, 2004
PubMed
Summary
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Bedside laparotomy (BSL) in critically ill trauma patients, though high-risk, achieved a 50.7% survival rate. Infectious complications like intra-abdominal abscesses and fistulas were infrequent, suggesting BSL can be a viable option.

Area of Science:

  • Trauma Surgery
  • Critical Care Medicine
  • Surgical Outcomes

Background:

  • Critically ill trauma patients often require emergent laparotomy in the intensive care unit (ICU) due to instability for operating room transfer.
  • Damage control laparotomy patients have high reoperation rates and a significant mortality (50-60%).
  • Bedside laparotomy (BSL) is sometimes necessary when patients cannot be transferred to the OR.

Purpose of the Study:

  • To evaluate the mortality and intra-abdominal complication rates in patients undergoing bedside laparotomy (BSL) with the abdomen intentionally left open.
  • To test the hypothesis that BSL with an open abdomen leads to unacceptably high mortality or complications.

Main Methods:

  • A retrospective chart review was conducted using the Trauma Registry.

Related Experiment Videos

  • Data from 11,096 trauma admissions between March 1996 and May 2000 were analyzed.
  • Seventy-five patients underwent 95 BSL procedures, with outcomes stratified by Injury Severity Score (ISS), base deficit (BD), lactate (LA), and transfusion requirements.

    • Main Results:

    • The study included 75 patients who underwent 95 BSLs, with a mean ISS of 50.6.
    • Indications for BSL included abdominal compartment syndrome (49.5%), suspected infection (19.0%), and washout procedures (14.7%).
    • Overall mortality was 49% (39.2% within 72 hours, 17.4% late mortality), with late deaths attributed to multiple organ failure, not surgical complications. Intra-abdominal abscesses occurred in 6.5% and fistulas in 10.9% of survivors.

    Conclusions:

    • Despite the extreme acuity of patients undergoing BSL, a survival rate of 50.7% was achieved.
    • Rates of intra-abdominal abscess and fistula formation were low in patients managed with an open abdomen after BSL.
    • BSL in critically ill trauma patients can be performed with acceptable complication rates and a significant survival benefit.