Timing matters: Delayed surgery increases mortality for blunt hollow viscus injury

BACKGROUND: Immediate surgical exploration is recommended for suspected hollow viscus injury (HVI) following blunt trauma. However, diagnostic uncertainty can lead to delayed operative management. We aimed to evaluate if delayed bowel resection/repair (DBR), defined as ≥8 hours after emergency department arrival, was independently associated with increased mortality in blunt trauma patients. We also sought to identify risk factors associated with DBR. METHODS: The Trauma Quality Improvement Program database (2017-2024) was queried for admitted adults with blunt abdominal trauma (abdomen abbreviated injury scale grade ≥2) who underwent bowel resection/repair. Patients who were transferred from another facility or died within 8 hours were excluded. Patients undergoing early bowel resection <8 hours (EBR) were compared with patients undergoing DBR (≥8 h). Multivariable logistic regression evaluated the association between DBR and mortality, controlling for age, severe head and thoracic injury, intubation within 1 hour of arrival, injury to the small bowel, colon, or rectum, and blood transfusion within 4 hours. RESULTS: Of 33,728 patients undergoing bowel resection/repair, 16,010 (47.5%) underwent DBR. The DBR cohort had lower rates of small bowel (49.6% vs. 53.9%, p<0.001) and colon (46.7% vs. 49.7%, p<0.001) injuries, but similar rates of rectal injury (4.4% vs. 4.1%, p=0.166). Injuries to the liver (26.8% vs. 20.8%), spleen (28.2% vs. 23.4%), and kidney (12.9% vs. 9.0%) were more frequent in the DBR cohort (all p<0.001). DBR patients had an increased associated risk of mortality (13.0% vs. 8.5%, OR 1.21, 95% CI: 1.12-1.30, p<0.001). Small bowel injury was the only independent factor with decreased associated risk of DBR (OR 0.93, CI: 0.89-0.97, p=0.001). CONCLUSION: Delayed operative management for blunt HVI occurs more often in patients with solid organ injuries and is independently associated with increased mortality. These findings highlight the importance of early detection and timely surgical management of HVI. LEVEL OF EVIDENCE: Therapeutic/Care Management, Level IV.