Utility of laparoscopy for blunt abdominal trauma management: A National analysis

Abstract Purpose Although laparoscopy has been adopted by other surgical specialties, laparotomy remains the standard in trauma. We evaluated the use of laparoscopy in patients following blunt abdominal trauma. Methods Stable patients (systolic blood pressure ≥ 100mmHg and Glasgow coma score ≥ 13) and an abdominal operation for blunt trauma within 24 h were identified from the Trauma Quality Improvement Program database over 2016–2021. Individuals with a non-abdominal AIS ≥ 3 were excluded. Patients were categorized by index procedure: Open only (OPEN), laparoscopy only (LAP), or laparoscopy converted to open (LCO). Patients were further stratified by low (< 3) and high ( ≥ 3) abdominal-AIS. Clinical characteristics and outcomes including in-hospital complications and ICU and hospital length of stay (LOS) were compared. Results A total of 14,637 patients were included: 83% OPEN, 11% LAP, 6% LCO. Patients were primarily male (67%) with a median age of 36 years. Groups did not clinically differ by ISS and abdominal-AIS. LAP had significantly fewer subsequent abdominal procedures (4% vs. 14%OPEN, p < 0.001) and fewer complications, including infections and unplanned returns to the operating room ( p < 0.001). LAP also had shorter ICU and hospital LOS, which persisted even when stratifying by low and high abdominal-AIS ( p < 0.01). Conclusion Lap is rarely used but associated with fewer complications and subsequent procedures in stable patients with blunt abdominal trauma. These results from a large, nationwide database suggest an opportunity to safely increase LAP use in stable trauma patients.