Trends and outcomes following diagnostic laparoscopy for blunt abdominal trauma in the United States.

Abstract

The role of diagnostic laparoscopy in adults with blunt abdominal trauma and the effect of negative laparoscopy on mortality is not well delineated. We reviewed the National Trauma Data Bank (2007-2019) for adults sustaining blunt abdominal trauma who underwent operative intervention. We performed a doubly robust, augmented inverse propensity weighted multivariable logistic regression to estimate the effect of a negative diagnostic laparoscopy on mortality in adults with operative blunt abdominal trauma. 87,864 patients met the inclusion criteria. Diagnostic laparoscopy occurred in 6.6% (n = 5816) of patients, with a 21.1% (n = 1226) conversion to laparotomy rate. The rate of negative diagnostic laparoscopy was 28.6% (n = 1665). Negative laparoscopy patients had a 49% reduction in odds of mortality (OR 0.51, 95%CI 0.47 - 0.56, p < 0.001) compared to negative laparotomy patients. Patient's that underwent laparoscopy, found to have intra-abdominal injury, had a similar reduction in odds of mortality compared to negative laparotomy patients (OR 0.54, 95% CI 0.51 - 0.57, p < 0.001). Diagnostic laparoscopy may be safe for adults with blunt abdominal trauma and prevent significant morbidity and mortality from a negative laparotomy.