Potentially low-value operative care in abdominal trauma: A retrospective National Trauma Data Bank study

We currently lack national data on adherence to American College of Surgeons recommendations on nonoperative management for hemodynamically stable adults with solid-organ injuries. We aimed to estimate the incidence and interhospital variation in potentially low-value operative management for adults with blunt solid abdominal organ injuries.

We included adults with blunt solid-organ injury eligible for nonoperative management (grades I-IV spleen and liver and grade I-III kidney, hemodynamically stable on arrival, and no blood products used in the emergency department) who were admitted to trauma centers in the United States that submitted data to the National Trauma Data Bank between 2016 and 2019. Low-value operative management was defined as laparotomy within 6 hours of admission. Interhospital variation was measured using risk-adjusted intraclass correlation coefficients (<5% low, 5-20% moderate, and >20% high).

In total, 62,601 adults in 324 American College of Surgeons-verified level I-III trauma centers and 297 state-designated centers were included. Adjusted incidences of potentially low-value operative management were 2.7% overall (6.8%, 2.1%, 0.8%, for spleen, liver, and kidney injuries) and 2.6%, 2.5%, and 3.0% for American College of Surgeons-verified level I, level II, and state-designated centers. Interhospital variation was moderate to high with a global intraclass correlation coefficient of 21% and intraclass correlation coefficients of 18%, 25%, and 21% for American College of Surgeons-verified level I, level II, and state-designated trauma centers, respectively.

Results suggest that low-value operative management is uncommon in US trauma centers, but variation between same-level trauma centers is moderate to high. Future research should strive to identify determinants, and assess impact on patient outcomes.