UNNECESSARY LAPAROTOMIES FOR TRAUMA - A PROSPECTIVE-STUDY OF MORBIDITY

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.