Impact of Time-to-operation on In-hospital Mortality of Trauma Patients with Abdominal Injury Who Underwent Door-to-door Laparotomy

Tanyamon Kittidumkerng; Osaree Akaraborworn; Burapat Sangthong; Komet Thongkhao

doi:10.31584/jhsmr.20241093

Authors

Tanyamon Kittidumkerng Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Osaree Akaraborworn Division of Trauma and Critical Care, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Burapat Sangthong Division of Trauma and Critical Care, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Komet Thongkhao Division of Trauma and Critical Care, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.

DOI:

https://doi.org/10.31584/jhsmr.20241093

Keywords:

abdominal injury, mortality, time-to-operation

Abstract

Objective: Assessing the impact of time-to-operation, defined as the time from injury to incision, on in-hospital mortality of patients with abdominal injury who underwent door-to-door laparotomy was the primary objective. Other objectives were assessing the impact of time-to-operation on 24-hour mortality, hospital length-of-stay, and intensive-care-unit-free days of this population.
Material and Methods: This retrospective study examined 15-year and older patients with abdominal injuries who underwent door-to-door laparotomy in Songklanagarind Hospital between January 1st, 2015 and December 31st, 2018. Univariable and multivariable statistical analyses of the associations between the variables and in-hospital mortality were done.
Results: Among the 65 patients who met the inclusion criteria, 17 patients died, mostly due to exsanguination. The median time-to-operation was 165 minutes, with a maximum of 480 minutes and a minimum of 55 minutes. There were no statistically significant impacts of time-to-operation on in-hospital and 24-hour mortalities, hospital length-of-stay, or Intensive care unit (ICU)-free days. Multivariable analysis revealed three factors related to in-hospital mortality: Injury Severity Score (ISS) [adjusted odds ratio (OR) 1.09, p-value=0.002, 95% confidence interval (95% CI) 1.022, 1.159], shock [adjusted OR 12.73, p-value=0.008, 95% CI 1.428,113.488], and Glasgow Coma Scale (GCS) score <15 [adjusted OR 15.43, p-value=0.004, 95% CI 1.95, 122.106].
Conclusion: There were no significant impacts of time-to-operation on in-hospital and 24-hour mortalities of patients with abdominal injury who underwent door-to-door laparotomy. Patients with higher ISS, signs of shock, and/or GCS score lower than 15 had higher in-hospital mortality.

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