Bm. Renz et Dv. Feliciano, UNNECESSARY LAPAROTOMIES FOR TRAUMA - A PROSPECTIVE-STUDY OF MORBIDITY, The journal of trauma, injury, infection, and critical care, 38(3), 1995, pp. 350-356
Objective: Despite advances in diagnostic techniques, unnecessary lapa
rotomies (no repairs/no drains) are still performed in trauma centers.
The true risks of such procedures are unclear. Our hypothesis was tha
t the overall incidences of complications after an unnecessary laparot
omy for trauma that have been reported in the literature were signific
ant underestimates because of flaws in study design. To test our hypot
hesis, a prospective study to record all perioperative complications i
n patients undergoing an unnecessary laparotomy for trauma was perform
ed. Design: Prospective case series. Measurements and Main Results: Th
e main outcome measures were perioperative complications. An unnecessa
ry laparotomy was performed in 254 patients who sustained trauma. The
mechanism of injury was a penetrating wound in 98% of the patients. Co
mplications occurred in 41.3% of the patients (n = 105) and included a
telectasis (15.7%), postoperative hypertension that required medical t
reatment (11.0%), pleural effusion (9.8%), pneumothorax (5.1%), prolon
ged ileus (4.3%), pneumonia (3.9%), surgical wound infection (3.2%), s
mall bowel obstruction (2.4%), urinary infection (1.9%), and others. C
omplication rates for patients who did (n = 111) and did not (n = 143)
have an associated injury were 61.3% and 25.9%, respectively (p = 0.0
001). Complications occurred in 19.7% of 81 patients who did not have
an associated injury and who did not have intraperitoneal or retroperi
toneal penetration. The mortality rate for the entire series was 0.8%
and was unrelated to the unnecessary laparotomies. Conclusions: Unnece
ssary laparotomies for trauma result in a significant morbidity when c
omplications are recorded prospectively. Current efforts to reduce the
incidence of these unnecessary procedures without increasing that of
missed injuries are obviously worthwhile.