The Impact of Trauma Center Establishment on Laparotomy Patterns and Outcomes in Severe Hemoperitoneum Patients

Abstract

The Impact of Trauma Center Establishment on Laparotomy Patterns and Outcomes in Severe Hemoperitoneum Patients Min A Lee, Jungnam Lee, Min Chung, Giljae Lee, Jaejeong Park, Kangkook Choi, Byung Chul Yoo Department of Surgery, Gil Medical Center, Gachon University, Incheon, Korea. kane2123@gilhospital.com Received: 9 November 2016 • Revised: 13 February 2017 • Accepted: 1 March 2017 Abstract PURPOSE The establishment of the trauma system has changed the quality of trauma care in many countries. As one of the first designated level I trauma centers in Korea, we hypothesized that there were changes in laparotomy patterns and subsequent survival rates after the center was established. METHODS This was a 5-year retrospective study of all severe hemoperitoneum patients who were transfused with more than 10 units of packed red blood cells (RBCs) within 24 h of hospitalization. Variables related to trauma were collected throughout the study period, and the patients admitted before (period 1) and after (period 2) the establishment of a trauma center were compared. RESULTS Forty-five patients were managed from January 2009 to March 2015. The baseline patient characteristics of the two groups, including age, Injury Severity Score, blood pressure, and hemoglobin levels, were similar. The time to the operating room (OR) was 144.3±51.5 min (period 1) and 79.9±44.1 min (period 2) (p<0.0001). Damage control surgery (DCS) was performed in 17% of patients during period 1 and in 73% during period 2. The number of actual survivors (n=10) was higher than expected (n=8) in period 2. CONCLUSION This is the first study analyzing the impact of a trauma center on the management of specific injuries, such as severe hemoperitoneum, in patients in Korea. During the study, the time to OR was shortened and DCS was used to a greater extent as a surgical procedure.