Emergency surgery for blunt abdominal trauma in polytrauma – the impact of time to laparotomy on outcomes

Purpose Blunt abdominal trauma (BAT) is common in polytrauma patients. Emergency surgery is required for haemodynamically significant solid organ injury and intra-abdominal hollow organ injury. The effect of time to surgery on outcomes in patients requiring emergency laparotomy remains uncertain. Materials & methods Adult polytrauma patients (ISS > 16) who underwent emergency laparotomy for blunt abdominal trauma between 1996 and 2020 from a trauma registry of a single level one trauma centre were included. Patients were divided into two groups based on the time elapsed from admission to emergency laparotomy: “Super Early” (≤ 60 min) and “Early” (60–180 min). Length of stay (LOS), intensive care unit (ICU)-LOS, ventilation time, re-look operations and mortality were assessed. Adjusted logistic regression was used to determine the independent predictive parameters, including timing of surgery, for mortality. Results The study included 190 polytrauma patients with concomitant blunt abdominal trauma (mean age 42 years (± 17), median ISS of 36 (IQR: 19)). There were 95 patients in each group. Patients in the “Super Early” group had a compromised haemodynamic status and a higher ISS. Liver injury and serous membrane injury were more common in the super early group. The mortality rate was significantly higher in the “Super Early” group (51.6%) compared to the “Early” group (26.3%) ( p < 0.001). Death due to haemorrhagic shock was significantly more frequent in the “Super Early” group (36.8%) compared to the “Early” group (13.7%) ( p < 0.001). A regression model was adjusted to determine the independent predictors of mortality. Time to emergency laparotomy was not an independent predictor of mortality. However, increased ISS (OR = 1.04, p = 0.049), age (OR = 1.03, p = 0.037) and decreased systolic blood pressure (OR = 0.98, p = 0.025) were found to be significant predictors of mortality. Conclusion The timing of surgery showed no independent association with mortality as long as an emergency laparotomy was performed within 3 h of admission. The data suggests that patient-specific characteristics, injury severity and clinical status are more important for survival than the timing of an early emergency laparotomy. Future research should focus on determining the role of delayed laparotomy on outcomes in specific subgroups of patients.