A bedside laparotomy protocol for unstable trauma and emergency general surgery patients resulted in an overall in-hospital mortality rate of 23.3% and an emergent return to OR rate of 5.8%.
Cohort (n=60)
Does a bedside laparotomy protocol maintain patient safety while reducing OR use in unstable trauma patients?
A bedside laparotomy protocol in unstable trauma patients is feasible, with a low rate of emergent return to the OR and potential cost savings.
Bedside laparotomy (BSL) was introduced as a heroic procedure in trauma patients too unstable for safe transport to the operating room (OR). We hypothesize a BSL protocol would maintain patient safety while reducing OR use. Patients were prospectively entered into a BSL protocol from July 2002 to June 2003 and retrospectively reviewed. Protocol indications for BSL were abdominal compartment syndrome, decompensation due to hemorrhage, washout/closure, and sepsis in a patient too unstable for safe transport to the OR. Primary outcomes were mortality, emergent return to OR, and primary fascial closure (PFC). Trauma operating room charges and OR time were analyzed. One hundred thirty-three BSL were performed on 60 patients with an overall mortality of 23.3 per cent (14/60). There was an average of 2.2 BSL per patient (range 1-8). Indications for BSL were 1) explore/washout (n = 100, 75.2%), 2) decompression (n = 14, 10.5%), 3) infection/abscess (n = 12, 9.0%), 4) hemorrhage (n = 7, 5.3%). Five of 133 BSL (5.8%) were emergently returned to the OR because of perforation or compromised bowel. Trauma OR charges were dollar 5,300 per cases with 2.12 hours per cases. The protocol standardized the conduct of BSL procedure to allow for a low return to OR rate of 5.8 per cent and had an overall in-hospital mortality rate of 23.3 per cent. Primary fascial closure of the abdomen had a significantly reduced hospital stay. BSL allowed trauma OR charges of dollar 5,300 per cases with 2.12 hours per cases savings.
Diaz et al. (Tue,) conducted a cohort in Trauma and emergency general surgery (n=60). Bedside laparotomy (BSL) protocol was evaluated on Mortality, emergent return to OR, and primary fascial closure (PFC). A bedside laparotomy protocol for unstable trauma and emergency general surgery patients resulted in an overall in-hospital mortality rate of 23.3% and an emergent return to OR rate of 5.8%.