Trauma Laparotomy in the UK: A Prospective National Service Evaluation.

Background Trauma patients requiring abdominal surgery have significant morbidity and mortality, yet no specific quality indicators are measured in the trauma systems of the United Kingdom. The aims of this study were to describe the characteristics and outcomes of emergency abdominal trauma surgery patients and key processes of care. Study Design A prospective multicentre service evaluation was conducted within all of the major trauma centres in the UK. The study was conducted over six months from January 2019. Patients of any age undergoing laparotomy or laparoscopy within 24 hours of injury were included. Existing standards from related emergent conditions were used. Results The study included 363 patients from 34 hospitals. The majority were young males with no co-morbidities who required surgery for control of bleeding (51%). Over 90% received attending-delivered care in the emergency department (318/363) and operating room (321/363). The overall mortality rate was nine percent. Patients suffering blunt trauma had a greater risk of death compared to patients with penetrating injuries (16.6% vs 3.8%, risk ratio 4.3 [95% CI 2.0-9.4]). Patients who activated the Major Hemorrhage Protocol (MHP) and received a blood transfusion (n=154) constituted a high-risk subgroup, accounting for 45% of the study cohort but 97% of deaths and 96% of blood components transfused. The MHP subgroup had expedited timelines from ED arrival to knife-to-skin (MHP: 119 (64-218) minutes vs No MHP: 211 (135-425) minutes, p Conclusion The majority of trauma patients requiring emergency abdominal surgery receive a high standard of expedited care in a maturing national trauma system. Despite this, mortality and resource utilization among high-risk patients remains substantial.