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Mortality after emergent trauma laparotomy: A multicenter, retrospective study.

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  • 1From the The University of Texas McGovern Medical School at Houston (J.A.H., J.B.H.), Houston, Texas; The University of Southern California Keck School of Medicine (T.M., K.I.), Los Angeles, California; Harvard Medical School (M.A.M.-A., D.R.K.), Boston, Massachusetts; Mayo Clinic (A.J.C., M.D.Z.), Rochester, Minnesota; Baylor College of Medicine (S.A., S.R.T.), Houston, Texas; The University of Alabama School of Medicine (R.L.G., J.D.K.), Birmingham, Alabama; The Rutgers New Jersey Medical School (J.A.B., D.H.L.), Newark, New Jersey; The University of Maryland School of Medicine (K.C., D.M.S.), Baltimore, Maryland; The University of Washington Harborview Medical Center (L.C., E.M.B.), Seattle, Washington; The West Virginia University School of Medicine (A.W.), Morgantown, West Virginia; Oregon Health & Science University (V.J.U.P., M.A.S.), Portland, Oregon; and The University of Michigan Medical School (J.R.C.-B., H.B.A.), Ann Arbor, Michigan.

The Journal of Trauma and Acute Care Surgery
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Mortality for emergent trauma laparotomies remains high at 21%, with hemorrhage causing most deaths. Hypotensive patients face a concerning 46% mortality rate, unchanged over two decades.

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Area of Science:

  • Trauma Surgery
  • Emergency Medicine
  • Surgical Outcomes Research

Background:

  • Two decades ago, mortality for hypotensive trauma patients undergoing emergent laparotomy was 40%.
  • Despite interventions, few have demonstrably improved outcomes for this critical patient group.
  • Current mortality rates for emergent trauma laparotomy require re-evaluation.

Purpose of the Study:

  • To determine current mortality rates for patients undergoing emergent trauma laparotomy.
  • To assess changes in outcomes for trauma patients requiring emergent surgical intervention.
  • To identify the primary causes of death in this cohort.

Main Methods:

  • Retrospective cohort study of adult emergent trauma laparotomies (2012-2013) at 12 Level I trauma centers.
  • Emergent laparotomy defined as ED admission to surgical start ≤90 minutes.
  • Hypotension defined as ED systolic blood pressure (SBP) ≤90 mm Hg; cause and time to death analyzed.

Main Results:

  • 1,706 patients underwent emergent trauma laparotomy; 67% blunt trauma, 84% male, median age 31.
  • Overall mortality was 21%, with 60% of deaths due to hemorrhage.
  • Hypotensive patients had 46% mortality, with 65% of these deaths attributed to hemorrhage.

Conclusions:

  • The overall mortality rate for emergent trauma laparotomy is substantial at 21%, with hemorrhage as the leading cause of death.
  • Mortality for hypotensive trauma patients (SBP ≤90 mm Hg) remains high at 46%, showing no improvement over the past 20 years.
  • Urgent strategies are needed to address the persistent high mortality in hypotensive patients undergoing emergent trauma laparotomy.