Outcomes of the failure of selective nonoperative management of penetrating abdominal trauma

Joosten, J.J. (Hanneke) (2016) Outcomes of the failure of selective nonoperative management of penetrating abdominal trauma. thesis, Medicine.

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Abstract

Introduction: Over the past five decades there has been a shift from mandatory operative exploration to selective non-operative management (SNOM) in penetrating abdominal trauma(PAT). Besides all the proven benefits of SNOM, the main concern is the potential harm in patients who fail SNOM and eventually experience a delay in treatment. The aim of this study is to investigate if delayed surgery due to failed SNOM is associated with adverse effects in PAT patients. Methods: All patients presenting at the Trauma Centre of Groote Schuur Hospital, Cape Town in a 13-month period (05/15-06/16) were included. Patient groups were divided in patients who went immediately for surgery and patients who failed SNOM and then had surgery. Outcomes included mortality, morbidity rate and length of stay. Results: Of 485 patients, 219 (45%) were managed by SNOM of which 26 (12 %) failed the observation period and 266 (55%) with immediate surgery. The median time to OR was in the immediate surgery group 5 hours (Q1-Q3 2-8) and in the failed SNOM group 45 hours (Q1- Q3 27-68). Mortality was only observed in the immediate surgery group. There was no difference in the number of patients who had complications (failed SNOM 31% vs. 37% p=0.71), or in length of stay (failed SNOM median 7(5-10) vs. 7(5-12) p=0.95) Conclusion: Under a structured clinical protocol, the delay does not cause preventable mortality, morbidity or length of stay. Nevertheless further research has to be carried out to emphasize our results.

Item Type:	Thesis (Thesis)
Supervisor name:	El Moumni, Drs. M. and Trauma Division, Department of Surgery and University Medical Centre Groningen and Groningen, The Netherlands
Supervisor name:	Navsaria, Prof. P.H. and Trauma Division, Department of Surgery and Groote Schuur Hospital and University of Cape Town and Cape Town, South Africa
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:04
Last Modified:	25 Jun 2020 11:04
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2417

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