Patterns of negative trauma laparotomy worldwide: a sub-analysis of a global dataset

Purpose Trauma remains a major contributor to global disability. While the trauma laparotomy can be a life-saving procedure in abdominal injury, a select proportion are performed with no pathology identified intra-operatively, potentially exposing patients to unnecessary morbidity. We aimed to assess the global prevalence of negative laparotomy and identify any influencing factors at both the patient- and system-level. Methods This was a secondary analysis of the GOAL-Trauma study, a multicentre prospective international observational study on trauma laparotomy patients, conducted from April to December 2024. We defined a negative laparotomy as where no intra-abdominal injuries were identified during the index operation. A multivariable logistic regression was performed to identify predictive factors for a negative laparotomy. Results Of the 1769 patients included, 128 patients (7.2%) underwent a negative laparotomy. Regression analysis demonstrated that a penetrating mechanism of injury (OR 2.37, CI:1.53–3.69, p < 0.001) and a lower grade of surgeon (surgical registrar relative to consultant - OR 2.91, CI:1.90–4.47, p < 0.001) were independent predictors for negative laparotomy. Neither human development index nor hospital resource level impacted negative laparotomy rates. Conclusion One in every fourteen trauma laparotomies performed in our global cohort was negative, with injury type and surgeon experience having a significant deterministic role. As trauma systems develop globally, recognition in the value of both training and a structured assessment pathway is paramount. The rate of negative trauma laparotomy, either institutionally or regionally, may act as a useful benchmark of trauma system performance and warrants further exploration.