E. Scheiderer1, P. Parikh1, J. K. Shim1 1Wright State University Boonshoft School of Medicine,Surgery,Dayton, OH, USA
Introduction:
There is interest in performing laparoscopic surgery on trauma patients. Despite increasing experience and familiarity with laparoscopic skills, it is unknown whether trauma surgeons are increasingly doing more laparoscopic cases. This research reviewed predictors of the type of surgery, either laparoscopy versus laparoscopy converted to open, an abdominal trauma patient will undergo.
Methods:
In this retrospective study, we queried abdominal trauma (blunt or penetrating) patients who had laparoscopy vs laparoscopy converted to open procedure from 2006-2016 at a Level 1 Trauma Center. Standard descriptive statistics were analyzed using Cox Proportional Hazards Regression and Random Forest Classification.
Results:
A total of 55 patients were included for analysis. The LOS for the group of patients who received only laparoscopic surgery was shorter than the laparoscopic (n=26) and laparotomy group (n=29) by 5.4 days.
ISS, diffuse abdominal tenderness on arrival, smoking, diabetes, sex, and pulse were the best predictors of which type of surgery the patient would have. Using random forest analysis, these six variables were able to correctly determine the type of surgery the patients would undergo about 70% of the time.
Operative reports revealed several reasons for conversion. These included the uncertainty of another organ injury, difficulty visualization, herniation of abdominal organs into the thoracic cavity, and leakage of insufflation gas. 4 out of the 29 cases that were converted revealed a diaphragmatic injury.
Conclusion:
Based on our findings, we can conclude that laparoscopy is a beneficial option for treating patients who have abdominal trauma based on the decreased length of stay. Knowing which factors are more likely to necessitate a change to an open surgical procedure can help predict which abdominal trauma patients are the best candidates for laparoscopy.