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Original Research

Open Access

Mortality risk in stable patients with penetrating abdominal trauma: critical timing considerations

  • Heng-Fu Lin1,2
  • Shih-Ching Kang3
  • Yu-Chi-Kuo3
  • Yau-Ren Chang1
  • Chih-Yuan Fu3,4,5,*,
  • Faran Bokhari4,5

1Division of Trauma, Department of Surgery, Far Eastern Memorial Hospital, 22000 New Taipei City, Taiwan

2Graduate Institute of Medicine, Yuan Ze University, 32000 Taoyuan, Taiwan

3Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 333 Taoyuan, Taiwan

4Department of Trauma and Burn, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, USA

5Department of Surgery, Trauma Services, OSF Healthcare St Francis Medical Center, Peoria, IL 61637, USA

DOI: 10.22514/sv.2025.061 Vol.21,Issue 5,May 2025 pp.14-20

Submitted: 02 October 2024 Accepted: 08 February 2025

Published: 08 May 2025

*Corresponding Author(s): Chih-Yuan Fu E-mail: fucy@cgmh.org.tw

Abstract

Background: The management of penetrating abdominal trauma (PAT) remains controversial, particularly for patients with stable hemodynamics. This study evaluates the influence of timing—transportation, resuscitation, and time to abdominal surgery—on the outcomes of PAT patients with stable hemodynamics. Additionally, it investigates mortality-associated factors among non-survivors in this cohort. Methods: A retrospective analysis of the National Trauma Data Bank (2007–2015) identified PAT patients with stable hemodynamics (systolic blood pressure ≥90 mmHg) who underwent abdominal operations. Patients with unstable hemodynamics or delayed surgeries (>120 hours post-admission) were excluded. Demographics, emergency medical service (EMS) response time, emergency department (ED) duration, abbreviated injury scale (AIS) of abdomen, injury severity scores (ISS), and hollow viscus injury (HVI) presence were analyzed. Multivariate logistic regression determined mortality-associated factors. Results: Among the 31,662 PAT patients who underwent abdominal operations, 5900 patients (18.6%) had stable hemodynamics and underwent surgery more than 2 hours after ED arrival, which was the focus of this study. Among these patients, non-survivors were older, had prolonged EMS + ED times, higher abdominal AIS and ISS scores, and an increased presence of HVI. Time to surgery was not significantly associated with mortality (p = 0.450). Patients with HVI demonstrated a higher risk of mortality. Subset analyses revealed that non-survivors with HVI experienced significantly longer surgical delays compared to survivors. In contrast, no significant difference in time to abdominal surgery was observed between survivors and non-survivors among patients without HVI. Conclusions: For stable PAT patients, delayed surgery did not correlate with increased mortality. However, prolonged preoperative delays (EMS + ED) and the presence of HVI were significant risk factors for mortality. Optimizing EMS and ED workflows and prioritizing timely interventions for HVI are critical for improving outcomes.


Keywords

Penetrating abdominal trauma; Mortality; Time to surgery


Cite and Share

Heng-Fu Lin,Shih-Ching Kang,Yu-Chi-Kuo,Yau-Ren Chang,Chih-Yuan Fu,Faran Bokhari. Mortality risk in stable patients with penetrating abdominal trauma: critical timing considerations. Signa Vitae. 2025. 21(5);14-20.

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