Nontherapeutic Laparotomy in American Combat Casualties: A 10-year Review
BROOKE ARMY MEDICAL CENTER FORT SAM HOUSTON TX
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The civilian literature has expanded the indications for selective nonoperative management SNOM for abdominal trauma to minimize morbidity from nontherapeutic laparotomies NTLs however, this treatment modality remains controversial and rare in austere settings. This study aimed to quantify the percentage of NTL and incidence of failed SNOM performed in theater and to define each of their respective intra-abdominal-related morbidities. A retrospective evaluation of all patients who underwent a laparotomy from 2002 to 2011 during Operation Iraqi Freedom OIF and Operation Enduring Freedom OEF was performed for patients who survived a minimum of 24 hours. With the use of DRG International Classification of Diseases V9th Rev. procedure codes, a therapeutic laparotomy was defined by the presence of a defined intraperitoneal or retroperitoneal procedure an NTL was defined by the absence of a defined intraperitoneal or retroperitoneal procedure. Second, patients transferred from North American Treaty Organization Role II to Role III medical treatment facilities to be operated on were deemed failed SNOM. Finally, intra-abdominal complications and mortality were identified for patients undergoing therapeutic laparotomy, NTL, and failed SNOM. Blunt, burn, and penetrating injuries accounted for 38.5 n 490, 1.1 n 14, and 60.4 n 769 of all laparotomies in the OEF and OIF, respectively. Thirty-two percent of all laparotomies performed during the OEF and OIF campaigns were NTL specifically, the NTL rates in OEF and OIF were 38.2 and 28.6, respectively. In addition, 31.6 and 32.2 of all penetrating and blunt injury mechanisms resulted in an NTL, respectively. The percentage of all patients identified as failing SNOM was 7.5 n 95. The early intra-abdominal complication rate for failed SNOM and for all patients undergoing NTL was 2.1 and 1.7, respectively.
- Medicine and Medical Research