S. W. De Geus1, C. D. Barrett2, M. Neufeld1, C. D. Graham1, S. E. Byerly3, S. Ng1, M. B. Yaffe2, J. F. Tseng1, S. E. Sanchez1 1Boston Medical Center,General Surgery,Boston, MA, USA 2Beth Israel Deaconess Medical Center,General Surgery,Boston, MA, USA 3Ryder Trauma Center,Miami, FL, USA
Introduction: Non-operative management of penetrating trauma has been increasing in the last decade. The purpose of this study was to compare the outcomes of selective non-operative management (NOM) versus laparotomy (LAP) in patients with gunshot wounds to the abdomen.
Methods: Patients with gunshot wounds to the abdomen were extracted from the Healthcare Cost and Utilization Project Florida State Inpatient Database. Patients with brain and/or spinal cord injuries, or who were hemodynamically unstable were excluded. Propensity-score models were created predicting the odds of undergoing NOM. Patients were matched based on propensity-score. Inhospital mortality, complicationd, and length of stay were compared.
Results: In total, 743 patients were identified. 74% (n=548) of patients underwent LAP. Unadjusted, NOM was associated with age ≤28 year (59% vs. 51%; p=0.035), black/Hispanic race (73% vs. 63%; p=0.011), absence of insurance (51% vs. 39%; p=0.004), low-volume (< 10 abdominal gunshot wounds/year) treatment center (69% vs. 58%; p=0.005), a lower complication rate (14% vs. 27%; p<0.001), and shorter length of stay (median length of stay: 4 vs. 9 days; p<0.001). Unadjusted, in-hospital mortality (6% after NOM vs. 5% after LAP; p=0.853) was similar for both groups. After matching, baseline characteristics were equally distributed, with 170 patients in each group. Adjusted, NOM remained associated with shorter length of stay (median length of stay: 4 vs. 8 days; p<0.001). However, the prevalence of complications (14% after NOM vs. 19% after LAP: 25% vs. 22%; p=0.191) were comparable.
Conclusions: The results of this study suggest that NOM may be safe in well selected patients with abdominal gunshot wounds. NOM was associated with shorter length of stay, possibly reducing overall cost.