Impact of Time-to-operation on In-hospital Mortality of Trauma Patients with Abdominal Injury Who Underwent Door-to-door Laparotomy

Objective: Assessing the impact of time-to-operation, defined as the time from injury to incision, on in-hospital mortality of patients with abdominal injury who underwent door-to-door laparotomy was the primary objective. Other objectives were assessing the impact of time-to-operation on 24-hour mortality, hospital length-of-stay, and intensive-care-unit-free days of this population. Material and Methods: This retrospective study examined 15-year and older patients with abdominal injuries who underwent door-to-door laparotomy in Songklanagarind Hospital between January 1st, 2015 and December 31st, 2018. Univariable and multivariable statistical analyses of the associations between the variables and in-hospital mortality were done.Results: Among the 65 patients who met the inclusion criteria, 17 patients died, mostly due to exsanguination. The median time-to-operation was 165 minutes, with a maximum of 480 minutes and a minimum of 55 minutes. There were no statistically significant impacts of time-to-operation on in-hospital and 24-hour mortalities, hospital length-of-stay, or Intensive care unit (ICU)-free days. Multivariable analysis revealed three factors related to in-hospital mortality: Injury Severity Score (ISS) [adjusted odds ratio (OR) 1.09, p-value=0.002, 95% confidence interval (95% CI) 1.022, 1.159], shock [adjusted OR 12.73, p-value=0.008, 95% CI 1.428,113.488], and Glasgow Coma Scale (GCS) score <15 [adjusted OR 15.43, p-value=0.004, 95% CI 1.95, 122.106].Conclusion: There were no significant impacts of time-to-operation on in-hospital and 24-hour mortalities of patients with abdominal injury who underwent door-to-door laparotomy. Patients with higher ISS, signs of shock, and/or GCS score lower than 15 had higher in-hospital mortality.