Two Decades of Evolution in Abdominal Trauma Surgery: Trends, Outcomes, and Implications From an Australian Level 1...

Advances in imaging, non-operative management, and endovascular techniques have reshaped abdominal trauma care, but their impact on operative trends in blunt-dominant Australian trauma systems is incompletely described.

To describe temporal trends in operative and minimally invasive management of abdominal trauma at an Australian Level 1 trauma centre, and to discuss their implications.

A retrospective study of the Alfred Health Trauma Registry (2001-2024) identified adult major trauma (MT) patients (ISS > 12) undergoing emergency laparotomy, laparoscopy, or solid-organ embolisation within 24 h of admission. Temporal trends were assessed using linear regression and offset Poisson models. Sensitivity analyses used abdominal AIS ≥ 2 as the denominator.

Among 25 497 major trauma patients, 1330 (5.2%) underwent laparotomy, 107 (0.4%) laparoscopy, and 417 (1.6%) embolisation. Annual major trauma presentations increased from 643 to 1498, while the number of patients with abdominal AIS ≥ 2 also rose. Laparotomy rates declined significantly over time, from 10.7% to 2.7% of major trauma admissions (R² = 0.80; p < 0.01), with the decline persisting when abdominal AIS ≥ 2 was used as the denominator. Embolisation increased significantly, whereas laparoscopy volumes rose numerically but did not demonstrate a consistent statistically significant temporal increase.

Emergency trauma laparotomies have declined despite increasing trauma volume and abdominal injury burden, consistent with greater use of selective non-operative and endovascular strategies. These changes have implications for maintaining operative readiness within contemporary multidisciplinary trauma systems.