Trends and outcomes following diagnostic laparoscopy for blunt abdominal trauma in the United States
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Kathryn K Atkins1, Jared R Gallaher1, Andrew B Schneider1
1Department of Surgery, University of North Carolina at Chapel Hill, United States.
Background:
The role of diagnostic laparoscopy in adults with blunt abdominal trauma and the effect of negative laparoscopy on mortality is not well delineated.
Methods:
We reviewed the National Trauma Data Bank (2007-2019) for adults sustaining blunt abdominal trauma who underwent operative intervention. We performed a doubly robust, augmented inverse propensity weighted multivariable logistic regression to estimate the effect of a negative diagnostic laparoscopy on mortality in adults with operative blunt abdominal trauma.
Results:
87,864 patients met the inclusion criteria. Diagnostic laparoscopy occurred in 6.6% (n = 5816) of patients, with a 21.1% (n = 1226) conversion to laparotomy rate. The rate of negative diagnostic laparoscopy was 28.6% (n = 1665). Negative laparoscopy patients had a 49% reduction in odds of mortality (OR 0.51, 95%CI 0.47 - 0.56, p < 0.001) compared to negative laparotomy patients. Patient's that underwent laparoscopy, found to have intra-abdominal injury, had a similar reduction in odds of mortality compared to negative laparotomy patients (OR 0.54, 95% CI 0.51 - 0.57, p < 0.001).
Conclusion:
Diagnostic laparoscopy may be safe for adults with blunt abdominal trauma and prevent significant morbidity and mortality from a negative laparotomy.
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