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Laparoscopic Surgery in Abdominal Trauma: Retrospective Study in a Trauma Center in Brazil
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Scientific Poster Presentations: 2017 Clinical Congress
after. While the pre-protocol group was slightly more severely injured there was no difference in age, number of rib fractures, flail segments, or utilization of CT imaging. Implementation of the protocol was associated with faster time to SICU admission. CONCLUSIONS: Implementation of our rib fracture protocol was associated with a decreased time in the ED. This was primarily by decreasing the time from rib fracture diagnosis to SICU admission.
Laparoscopic Surgery in Abdominal Trauma: Retrospective Study in a Trauma Center in Brazil Carlos Augusto M Menegozzo, MD, Sergio HB Damous, MD, FACS, Pedro HF Alves, MD, Celso O Bernini, MD, Edivaldo Utiyama, MD, PhD Hospital das Clinicas of the University of Sao Paulo, Sao Paulo, Brazil INTRODUCTION: Laparoscopy is well-established in the elective setting, and is being more used in emergency surgeries. However, laparoscopic management of trauma patients is still limited for various reasons, including lack of technical skills and resources, and scarce evidence of safety and feasibility. The aim of this study is to present our experience with laparoscopy in trauma patients. METHODS: Retrospective chart review of consecutive patients admitted during a period of 7 years in a Trauma Center in Brazil. We included all patients initially managed by laparoscopy. Demographic, clinical, intra and postoperative data were analyzed. RESULTS: The analysis included 94 patients. Seventy-five were male (79%), mean age was 31 + 12 years-old. Blunt mechanism was present In 43 cases (45%). Mean ISS was 13.8. The most common indications for laparoscopy were free fluid with no parenchymal injuries in 28 cases (31.6%%) followed by thoracoabdominal penetrating injury (29.5%). Of the laparoscopic procedures, 70 were positive, of which 17 required conversion and 33 were completed laparoscopically. Main reasons for conversion were the need for bowel suture or resection, in 9 patients. There were no missed injuries. There were 4 Clavien > 3 complications. Unnecessary exploratory laparotomies were avoided in 93.7% of the patients. CONCLUSIONS: Laparoscopic management of trauma patients is feasible and safe when carefully selected. Absence of missed injuries and incidence of only low grade complications are important findings. Among the advantages of laparoscopy, the avoidance of unnecessary exploratory laparotomies, and their complications, should be highlighted. Obesity Is Not Associated with Worse Outcomes after Penetrating Trauma Charlie Fredericks, MD, James R Yon, MD, Molly Morton, Samuel Kingsley, MD, Sameer Gupta, Andrew J Dennis, DO, FACS, Kimberly T Joseph, MD, FACS, Frederic L Starr, MD, FACS, Kimberly K Nagy, MD, FACS, Faran Bokhari, MD Cook County Trauma Unit, Chicago, IL
J Am Coll Surg
INTRODUCTION: Trauma surgeons are encountering an increasing number of obese patients. The literature has been mixed regarding outcomes of these patients. However, most studies only include blunt trauma patients, with few studies including penetrating trauma. The aim of this study was to evaluate the outcomes of victims of penetrating trauma when correlated for body mass index (BMI). METHODS: A retrospective review of our database was performed for the 2013 calendar year. Age, sex, mechanism of injury, ISS (injury severity score), ICU days, hospital days, disposition, imaging performed in the first 24 hours, procedures, operations, open abdomen rates, and in-hospital mortality were collected in patients grouped by BMI. National rates of obesity were also compared with our center. RESULTS: All victims of intentional penetrating trauma were identified (n¼882). Prisoners, minors, and patients with nonsurvivable injuries were excluded, leaving 709 patients to be analyzed. BMI is not associated with an increased ISS, in-hospital mortality, amount of operations performed over the hospital stay, or open abdomen rates. There was no difference between BMI and presentation to our trauma center when compared to the national average. Hospital discharge disposition to rehabilitation center or long-term acute care facility is correlated with BMI (p<0.05). CONCLUSIONS: In this largest series to date, obese patients with penetrating injuries do not experience higher in-hospital mortality, worse injuries, or undergo more testing and operations. They are less likely to be discharged to home than normal weight individuals. The need for rehabilitative services at discharge should be anticipated early. Outcomes of a Pan-Scan Approach for Ground Level Falls in the Elderly Joshua Mark, MD, Rakesj R Gandhi, MD, PhD, Elizabeth L Price, Jessica Laureano Phillips, Michael Collyer, PhD, Therese M Duane, MD, FACS, FCCM John Peter Smith Health Network, Fort Worth, TX; Baylor University Medical Center, Dallas, TX INTRODUCTION: This project focused on the outcomes and distribution of injuries for ground level falls within the elderly population in order to determine the utility of a pan-scan approach. METHODS: A retrospective review was performed using our Level 1 trauma registry from 2007 to 2015. Data were compiled for elderly adults (55 and older) evaluated after ground level falls (GLF). We compared demographics, distribution of injuries and outcomes for patients who received pan-scans (CT of the head, cervical spine, chest, abdomen and pelvis) vs those who did not. RESULTS: A total of 1,589 patients were included; 533 (33.5%) in the pan scan (PS) group and 1056 (66.5%) in the non pan scan (NPS) group. Based on initial hemodynamics, the PS group was more physiologically compromised and more frequently intubated. PS patients had a higher ISS and were more frequently admitted to
Scientific Poster Presentations: 2017 Clinical Congress
after. While the pre-protocol group was slightly more severely injured there was no difference in age, number of rib fractures, flail segments, or utilization of CT imaging. Implementation of the protocol was associated with faster time to SICU admission. CONCLUSIONS: Implementation of our rib fracture protocol was associated with a decreased time in the ED. This was primarily by decreasing the time from rib fracture diagnosis to SICU admission.
Laparoscopic Surgery in Abdominal Trauma: Retrospective Study in a Trauma Center in Brazil Carlos Augusto M Menegozzo, MD, Sergio HB Damous, MD, FACS, Pedro HF Alves, MD, Celso O Bernini, MD, Edivaldo Utiyama, MD, PhD Hospital das Clinicas of the University of Sao Paulo, Sao Paulo, Brazil INTRODUCTION: Laparoscopy is well-established in the elective setting, and is being more used in emergency surgeries. However, laparoscopic management of trauma patients is still limited for various reasons, including lack of technical skills and resources, and scarce evidence of safety and feasibility. The aim of this study is to present our experience with laparoscopy in trauma patients. METHODS: Retrospective chart review of consecutive patients admitted during a period of 7 years in a Trauma Center in Brazil. We included all patients initially managed by laparoscopy. Demographic, clinical, intra and postoperative data were analyzed. RESULTS: The analysis included 94 patients. Seventy-five were male (79%), mean age was 31 + 12 years-old. Blunt mechanism was present In 43 cases (45%). Mean ISS was 13.8. The most common indications for laparoscopy were free fluid with no parenchymal injuries in 28 cases (31.6%%) followed by thoracoabdominal penetrating injury (29.5%). Of the laparoscopic procedures, 70 were positive, of which 17 required conversion and 33 were completed laparoscopically. Main reasons for conversion were the need for bowel suture or resection, in 9 patients. There were no missed injuries. There were 4 Clavien > 3 complications. Unnecessary exploratory laparotomies were avoided in 93.7% of the patients. CONCLUSIONS: Laparoscopic management of trauma patients is feasible and safe when carefully selected. Absence of missed injuries and incidence of only low grade complications are important findings. Among the advantages of laparoscopy, the avoidance of unnecessary exploratory laparotomies, and their complications, should be highlighted. Obesity Is Not Associated with Worse Outcomes after Penetrating Trauma Charlie Fredericks, MD, James R Yon, MD, Molly Morton, Samuel Kingsley, MD, Sameer Gupta, Andrew J Dennis, DO, FACS, Kimberly T Joseph, MD, FACS, Frederic L Starr, MD, FACS, Kimberly K Nagy, MD, FACS, Faran Bokhari, MD Cook County Trauma Unit, Chicago, IL
J Am Coll Surg
INTRODUCTION: Trauma surgeons are encountering an increasing number of obese patients. The literature has been mixed regarding outcomes of these patients. However, most studies only include blunt trauma patients, with few studies including penetrating trauma. The aim of this study was to evaluate the outcomes of victims of penetrating trauma when correlated for body mass index (BMI). METHODS: A retrospective review of our database was performed for the 2013 calendar year. Age, sex, mechanism of injury, ISS (injury severity score), ICU days, hospital days, disposition, imaging performed in the first 24 hours, procedures, operations, open abdomen rates, and in-hospital mortality were collected in patients grouped by BMI. National rates of obesity were also compared with our center. RESULTS: All victims of intentional penetrating trauma were identified (n¼882). Prisoners, minors, and patients with nonsurvivable injuries were excluded, leaving 709 patients to be analyzed. BMI is not associated with an increased ISS, in-hospital mortality, amount of operations performed over the hospital stay, or open abdomen rates. There was no difference between BMI and presentation to our trauma center when compared to the national average. Hospital discharge disposition to rehabilitation center or long-term acute care facility is correlated with BMI (p<0.05). CONCLUSIONS: In this largest series to date, obese patients with penetrating injuries do not experience higher in-hospital mortality, worse injuries, or undergo more testing and operations. They are less likely to be discharged to home than normal weight individuals. The need for rehabilitative services at discharge should be anticipated early. Outcomes of a Pan-Scan Approach for Ground Level Falls in the Elderly Joshua Mark, MD, Rakesj R Gandhi, MD, PhD, Elizabeth L Price, Jessica Laureano Phillips, Michael Collyer, PhD, Therese M Duane, MD, FACS, FCCM John Peter Smith Health Network, Fort Worth, TX; Baylor University Medical Center, Dallas, TX INTRODUCTION: This project focused on the outcomes and distribution of injuries for ground level falls within the elderly population in order to determine the utility of a pan-scan approach. METHODS: A retrospective review was performed using our Level 1 trauma registry from 2007 to 2015. Data were compiled for elderly adults (55 and older) evaluated after ground level falls (GLF). We compared demographics, distribution of injuries and outcomes for patients who received pan-scans (CT of the head, cervical spine, chest, abdomen and pelvis) vs those who did not. RESULTS: A total of 1,589 patients were included; 533 (33.5%) in the pan scan (PS) group and 1056 (66.5%) in the non pan scan (NPS) group. Based on initial hemodynamics, the PS group was more physiologically compromised and more frequently intubated. PS patients had a higher ISS and were more frequently admitted to