SELECTIVE NONOPERATIVE MANAGEMENT OF ABDOMINAL STAB WOUNDS - PROSPECTIVE, RANDOMIZED STUDY

In a prospective, randomized trial the safety and cost-effectiveness o f selective nonoperative management was compared to mandatory laparoto my in patients with abdominal stab wounds not requiring immediate lapa rotomy for hemodynamic instability, generalized peritonitis, or evisce ration of abdominal contents. Fifty-one patients were randomly assigne d to mandatory laparotomy or expectant nonoperative management and com pared for early (<90 days) mortality and morbidity, length of hospital stay, and hospital costs. There was no early mortality. The morbidity rate was 19% following mandatory laparotomy and 8% after observation (p = 0.26). Four patients (17%) managed nonoperatively required delaye d laparotomy. The hospital stay wvas shorter in the observation group (median 2 days versus 5 days; p = 0.002). About $2800 (US) was saved f or every patient who underwent successful nonoperative management. It is concluded that selective nonoperative management of abdominal stab wounds, although resulting in delayed laparotomy in some patients, is safe and the preferred strategy for minimizing the days in hospital wi th concomitant savings in hospital costs. Mandatory laparotomy detects some unexpected organ injuries earlier and more accurately but result s in a high nontherapeutic laparotomy rate and surgical management of minor injuries that in many cases could be managed nonoperatively.