GLOBAL VARIATION IN PATIENT FACTORS, INTERVENTIONS, AND POST-OPERATIVE OUTCOMES FOR THOSE UNDERGOING TRAUMA LAPAROTOMY: AN INTERNATIONAL PROSPECTIVE OBSERVATIONAL COHORT STUDY mb2583@cam.ac.uk

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GLOBAL VARIATION IN PATIENT FACTORS, INTERVENTIONS, AND POST-OPERATIVE OUTCOMES FOR THOSE UNDERGOING TRAUMA LAPAROTOMY: AN INTERNATIONAL PROSPECTIVE OBSERVATIONAL COHORT STUDY

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United Kingdom

Oral only

The trauma laparotomy is a definitive intervention for life-threatening abdominal injuries and cornerstone of trauma care globally. The ability to perform an emergency laparotomy is a recognised marker of safe and effective surgical care within a health system. However, global variation in the provision, context, and outcomes of the trauma laparotomy is unknown.

We conducted a prospective international observational study in 187 hospitals across 51 countries between April 2024 and December 2024. Patients who presented with a blunt or penetrating traumatic injury and underwent a laparotomy within 5 days were eligible. Countries were stratified by Human Development Index (HDI) tertile and the primary outcome measure was post-operative mortality at thirty days.

We included 1769 patients, comprising 31.8% from lower HDI tertile, 40.4% from middle HDI tertile, and 27.8% from upper HDI tertile. Median age was 30 years and 86% were male. Patients from upper HDI countries had a higher Injury Severity Score compared to those in middle or lower HDI countries (median 16 versus 9 and 9 respectively, p<0.001). 195 patients (11.0%) died in-hospital within thirty days of surgery. After adjustment, there was a higher mortality risk in the lower HDI tertile (OR 3.57, p<0.001) and middle HDI tertile (OR 1.89, p=0.030), compared to the upper HDI tertile.

Patients undergoing a trauma laparotomy in lower HDI settings were less severely injured and had a higher risk of death. There remains an opportunity to improve trauma care globally and expanding access must be matched by the development of quality services.