Abstract
Objective: To evaluate the safety of a policy of selective nonoperative management (SNOM) in patients with abdominal gunshot wounds. Summary Background Data: Selective nonoperative management is practiced extensively in stab wounds and blunt abdominal trauma, but routine laparotomy is still the standard of care in abdominal gunshot wounds. Methods: The authors reviewed the medical records of 1,856 patients with abdominal gunshot wounds (1,405 anterior, 451 posterior) admitted during an 8-year period in a busy academic level 1 trauma center and managed by SNOM. According to this policy, patients who did not have peritonitis, were hemodynamically stable, and had a reliable clinical examination were observed. Results: Initially, 792 (42%) patients (34% of patients with anterior and 68% with posterior abdominal gunshot wounds) were selected for nonoperative management. During observation 80 (4%) patients developed symptoms and required a delayed laparotomy, which revealed organ injuries requiring repair in 57. Five (0.3%) patients suffered complications potentially related to the delay in laparotomy, which were managed successfully. Seven hundred twelve (38%) patients were successfully managed without an operation. The rate of unnecessary laparotomy was 14% among operated patients (or 9% among all patients). If patients were managed by routine laparotomy, the unnecessary laparotomy rate would have been 47% (39% for anterior and 74% for posterior abdominal gunshot wounds). Compared with patients with unnecessary laparotomy, patients managed without surgery had significantly shorter hospital stays and lower hospital charges. By maintaining a policy of SNOM instead of routine laparotomy, a total of 3,560 hospital days and $9,555,752 in hospital charges were saved over the period of the study. Conclusion: Selective nonoperative management is a safe method for managing patients with abdominal gunshot wounds in a level 1 trauma center with an in-house trauma team. It reduces significantly the rate of unnecessary laparotomy and hospital charges.
| Original language | English |
|---|---|
| Pages (from-to) | 395-403 |
| Number of pages | 9 |
| Journal | Annals of Surgery |
| Volume | 234 |
| Issue number | 3 |
| DOIs | |
| State | Published - 2001 |
| Externally published | Yes |
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All Science Journal Classification (ASJC) codes
- Surgery
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Selective nonoperative management in 1,856 patients with abdominal gunshot wounds : Should routine laparotomy still be the standard of care? / Velmahos, George C.; Demetriades, Demetrios; Toutouzas, Konstantinos G.; Sarkisyan, Grant; Chan, Linda S.; Ishak, Rafik; Alo, Kathleen; Vassiliu, Pantelis; Murray, James A.; Salim, Ali; Asensio, Juan A.; Belzberg, Howard; Katkhouda, Namir; Berne, Thomas V.
In: Annals of Surgery, Vol. 234, No. 3, 2001, p. 395-403.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Selective nonoperative management in 1,856 patients with abdominal gunshot wounds
T2 - Should routine laparotomy still be the standard of care?
AU - Velmahos, George C.
AU - Demetriades, Demetrios
AU - Toutouzas, Konstantinos G.
AU - Sarkisyan, Grant
AU - Chan, Linda S.
AU - Ishak, Rafik
AU - Alo, Kathleen
AU - Vassiliu, Pantelis
AU - Murray, James A.
AU - Salim, Ali
AU - Asensio, Juan A.
AU - Belzberg, Howard
AU - Katkhouda, Namir
AU - Berne, Thomas V.
PY - 2001
Y1 - 2001
N2 - Objective: To evaluate the safety of a policy of selective nonoperative management (SNOM) in patients with abdominal gunshot wounds. Summary Background Data: Selective nonoperative management is practiced extensively in stab wounds and blunt abdominal trauma, but routine laparotomy is still the standard of care in abdominal gunshot wounds. Methods: The authors reviewed the medical records of 1,856 patients with abdominal gunshot wounds (1,405 anterior, 451 posterior) admitted during an 8-year period in a busy academic level 1 trauma center and managed by SNOM. According to this policy, patients who did not have peritonitis, were hemodynamically stable, and had a reliable clinical examination were observed. Results: Initially, 792 (42%) patients (34% of patients with anterior and 68% with posterior abdominal gunshot wounds) were selected for nonoperative management. During observation 80 (4%) patients developed symptoms and required a delayed laparotomy, which revealed organ injuries requiring repair in 57. Five (0.3%) patients suffered complications potentially related to the delay in laparotomy, which were managed successfully. Seven hundred twelve (38%) patients were successfully managed without an operation. The rate of unnecessary laparotomy was 14% among operated patients (or 9% among all patients). If patients were managed by routine laparotomy, the unnecessary laparotomy rate would have been 47% (39% for anterior and 74% for posterior abdominal gunshot wounds). Compared with patients with unnecessary laparotomy, patients managed without surgery had significantly shorter hospital stays and lower hospital charges. By maintaining a policy of SNOM instead of routine laparotomy, a total of 3,560 hospital days and $9,555,752 in hospital charges were saved over the period of the study. Conclusion: Selective nonoperative management is a safe method for managing patients with abdominal gunshot wounds in a level 1 trauma center with an in-house trauma team. It reduces significantly the rate of unnecessary laparotomy and hospital charges.
AB - Objective: To evaluate the safety of a policy of selective nonoperative management (SNOM) in patients with abdominal gunshot wounds. Summary Background Data: Selective nonoperative management is practiced extensively in stab wounds and blunt abdominal trauma, but routine laparotomy is still the standard of care in abdominal gunshot wounds. Methods: The authors reviewed the medical records of 1,856 patients with abdominal gunshot wounds (1,405 anterior, 451 posterior) admitted during an 8-year period in a busy academic level 1 trauma center and managed by SNOM. According to this policy, patients who did not have peritonitis, were hemodynamically stable, and had a reliable clinical examination were observed. Results: Initially, 792 (42%) patients (34% of patients with anterior and 68% with posterior abdominal gunshot wounds) were selected for nonoperative management. During observation 80 (4%) patients developed symptoms and required a delayed laparotomy, which revealed organ injuries requiring repair in 57. Five (0.3%) patients suffered complications potentially related to the delay in laparotomy, which were managed successfully. Seven hundred twelve (38%) patients were successfully managed without an operation. The rate of unnecessary laparotomy was 14% among operated patients (or 9% among all patients). If patients were managed by routine laparotomy, the unnecessary laparotomy rate would have been 47% (39% for anterior and 74% for posterior abdominal gunshot wounds). Compared with patients with unnecessary laparotomy, patients managed without surgery had significantly shorter hospital stays and lower hospital charges. By maintaining a policy of SNOM instead of routine laparotomy, a total of 3,560 hospital days and $9,555,752 in hospital charges were saved over the period of the study. Conclusion: Selective nonoperative management is a safe method for managing patients with abdominal gunshot wounds in a level 1 trauma center with an in-house trauma team. It reduces significantly the rate of unnecessary laparotomy and hospital charges.
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U2 - 10.1097/00000658-200109000-00013
DO - 10.1097/00000658-200109000-00013
M3 - Article
C2 - 11524592
AN - SCOPUS:17944374910
VL - 234
SP - 395
EP - 403
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 3
ER -