Table 6.
Comparisons of Pre- and Post-Intervention Cohorts
| |
Pre-intervention cohort |
Post-intervention cohort |
|
||
|---|---|---|---|---|---|
| |
Value (n = 139) |
% |
Value (n = 126) |
% |
p
|
| Demographics | |||||
| Age (Mean ± SD) | 33.1 ± 13.8 | 32.9 ± 13.1 | 0.883 | ||
| Gender (male) | 118 | 84.9 | 113 | 89.7 | 0.244 |
| Race (African American) | 99 | 71.2 | 87 | 69.0 | 0.699 |
| Weight (kg) [mean ± SD] | 80.1 ± 17.4 | 82.8 ± 20.0 | 0.244 | ||
| Median income of home zip code: <50% 50%–100% >100% |
30 70 39 |
21.6 50.4 28.1 |
25 64 37 |
19.8 50.8 29.4 |
0.933 |
| Transfer patient | 35 | 25.2 | 28 | 22.2 | 0.572 |
| Medical comorbidities | |||||
|---|---|---|---|---|---|
| Any significant medical comorbidity | 82 | 59.0 | 81 | 64.3 | 0.376 |
| More than one medical comorbidity | 35 | 25.2 | 35 | 27.8 | 0.632 |
| Blood alcohol level >80 mg/dL | 26 (n = 113) | 23.0 | 29 (n = 112) | 25.9 | 0.615 |
| Urine drug screen positive for amphetamines, barbiturates, cocaine, or non-medicinal opioids | 9 (n = 67) | 13.4 | 14 (n = 59) | 23.7 | 0.136 |
| Prior abdominal surgery | 18 | 12.9 | 20 | 15.9 | 0.498 |
| Mechanism of injury | |||||
|---|---|---|---|---|---|
| Penetrating injury | 105 | 75.5 | 97 | 77.0 | 0.783 |
| Mechanism of injury: Gunshot injury Stabbing or other penetrating injury Injury secondary to motor vehicle Other blunt injury |
72 33 28 6 |
51.8 23.7 20.1 4.3 |
77 20 24 5 |
61.1 15.9 19.0 4.0 |
0.447 |
| Severity of injury | |||||
|---|---|---|---|---|---|
| Overall ISS (median, IQR) | 16 (9–25) (n = 137) | 17 (9–26) (n = 123) | 0.106 | ||
| Abdominal abbreviated ISS (median, IQR) | 3 (2–4) (n = 137) | 3 (3–4) (n = 123) | 0.293 | ||
| Probability of survival (mean ± SD) | 0.913 ± 0.203 (n = 135) | 0.886 ± 0.249 (n = 120) | 0.355 | ||
| Initial lactate concentration (mmol/L) [mean ± SD] | 4.7 ± 2.0 (n = 13) | 4.8 ± 3.3 (n = 90) | 0.901 | ||
| Initial lactate concentration ≥2.2 mmol/L | 12 (n = 13) | 92.3 | 72 (n = 90) | 80.0 | 0.453 |
| Concomitant injuries | |||||
|---|---|---|---|---|---|
| Any chest injury | 53 | 38.1 | 53 | 42.1 | 0.514 |
| Any pelvic fracture | 26 | 18.7 | 32 | 25.4 | 0.188 |
| Major spine or spinal cord injury (excluding spinous/transverse process fractures) | 15 | 10.8 | 22 | 17.5 | 0.118 |
| Fracture or major soft tissue extremity injury | 36 | 25.9 | 39 | 31.0 | 0.362 |
| Extra-abdominal vascular injury | 5 | 3.6 | 11 | 8.7 | 0.080 |
| Any significant extra-abdominal injury | 93 | 66.9 | 96 | 76.2 | 0.095 |
| Timing of laparotomy | |||||
|---|---|---|---|---|---|
| Time in ED (min) [median, IQR] | 36 (22-89) (n = 138) | 44.5 (24-79) | 0.593 | ||
| Time from injury to operation (min) [median, IQR] | 118 (68-231) | 118.5 (77-217) | 0.780 | ||
| Laparotomy findings/details | |||||
|---|---|---|---|---|---|
| Negative laparotomy (no abdominal injury encountered) | 8 | 5.8 | 4 | 3.2 | 0.313 |
| Non-therapeutic laparotomy (no abdominal injury treated during laparotomy) | 13 | 9.4 | 14 | 11.1 | 0.637 |
| Any gastrointestinal tract injury | 66 | 47.5 | 70 | 55.6 | 0.189 |
| Any colorectal injury | 35 | 25.2 | 46 | 36.5 | 0.046 |
| Number of units of PRBCs transfused (median, IQR) | 0 (0–4) | 0 (0–4) | 0.947 | ||
| Any preoperative or intraoperative PRBC Transfusion | 68 | 48.9 | 61 | 48.4 | 0.934 |
| Transfusion of ≥10 units of PRBCs (pre- operative and intra-operative) | 13 | 9.4 | 16 | 12.7 | 0.384 |
| Duration of laparotomy (min) [mean ± SD] | 123.6 ± 57.6 | 133.5 ± 74.6 | 0.234 | ||
| Concomitant extra-abdominal procedure | 17 | 12.2 | 10 | 7.9 | 0.249 |
| Abdominal fascia left open at end of initial laparotomy | 29 | 20.9 | 29 | 23.0 | 0.672 |
| Subsequent management | |||||
|---|---|---|---|---|---|
| Postoperative ICU destination | 77 | 55.4 | 77 | 61.1 | 0.346 |
| Subsequent abdominal procedure | 36 | 25.9 | 34 | 27.0 | 0.841 |
| Subsequent extra-abdominal procedure | 36 | 25.9 | 36 | 28.6 | 0.625 |
| Days abdominal fascia left open (median, IQR) | 3 (2–8) (n = 29) | 2 (1–4) (n = 29) | 0.214 | ||
| Skin left open after final abdominal procedure | 55 | 39.6 | 62 | 49.2 | 0.115 |
| Postoperative use of vasopressors for >6 Hours | 16 | 11.5 | 9 | 7.1 | 0.224 |
| Follow-up | |||||
|---|---|---|---|---|---|
| Days of follow-up (median, IQR) | 45 (20 to >90) | 58.5 (21 to >90) | 0.446 | ||
| Any contact made after hospital discharge | 128 | 92.1 | 119 | 93.7 | 0.622 |
| Contact made ≥30 d after laparotomy | 100 | 71.9 | 93 | 73.8 | 0.733 |
| Contact made ≥90 d after laparotomy | 44 | 31.9 | 48 | 38.4 | 0.269 |
| Patients whose only contact at ≥30 d was by telephone | 7 (n = 11) | 63.6 | 10 (n = 17) | 58.8 | 0.799 |
SD = standard deviation; ISS = Injury Severity Score ; IQR = interquartile range; ED = emergency department; PRBCs = packed red blood cells; ICU = intensive care unit.