Reinforcing the role of rural trauma laparotomy.

IF 2 4区医学 Q2 SURGERY

Canadian Journal of Surgery Pub Date : 2026-03-03 Print Date: 2026-03-01 DOI:10.1503/cjs.013325

Richard C Chaulk, Laura Allen, Fran Priestap, Brad Moffat, W Robert Leeper, Neil Parry, Daryl Gray, Micheal Lewell, Alun Ackery, Kelly Vogt

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引用次数: 0

Abstract

Background: Hemodynamic instability due to abdominal injury in rural settings may necessitate damage-control laparotomy (DCL) before transferring patients to a lead trauma hospital (LTH) for care. Studies from the United States support performing DCL at rural hospitals (RHs), but data from Canada are lacking. This study compares outcomes between patients who received DCL at RHs and those treated directly at an LTH.

Methods: A retrospective cohort study over 15 years evaluated patients transferred to our centre after receiving DCL at an RH, matched 1:1 with those who went directly to an LTH for similar injuries. The primary outcome was abdominal injury-specific complications. Data were compared using Student t, Mann-Whitney U, and Fisher exact tests.

Results: We matched 21 patients transferred from RHs with 21 patients treated at our LTH. Injury types (blunt trauma: 81% v. 76%, p = 0.71) and Injury Severity Scores (median 34 v. 41, p = 0.37) were similar in the RH and LTH groups. Abdominal complications were common (21.4%), but no significant difference was found between the RH and LTH groups (28.6% v. 14.3%, p = 0.08). Secondary outcomes, including death (14.3% v. 28.6%, p = 0.26), open abdomen duration (1.0 d v. 0 d, p = 0.25), admission to the intensive care unit (95.2% v. 81.0%, p = 0.15), and hospital stay (16.0 d v. 17.0 d, p = 0.48) were comparable between the RH and LTH groups.

Conclusion: Though uncommon, DCL performed at RHs is not associated with higher morbidity or mortality rates. Collaboration between LTHs and RHs in select cases should be encouraged. Future research should focus on identifying ideal candidates, trauma system barriers, and ways to support this practice in rural settings.

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强化农村创伤剖腹手术的作用。

背景：农村地区由于腹部损伤引起的血流动力学不稳定可能需要在将患者转移到主要创伤医院（LTH）治疗之前进行损伤控制剖腹手术（DCL）。来自美国的研究支持在农村医院（RHs）实施DCL，但缺乏来自加拿大的数据。本研究比较了在RHs和直接在LTH接受DCL治疗的患者之间的结果。方法：一项超过15年的回顾性队列研究评估了在RH接受DCL后转移到我们中心的患者，与那些直接去LTH治疗类似损伤的患者1:1匹配。主要结局是腹部损伤特异性并发症。使用Student t、Mann-Whitney U和Fisher精确检验对数据进行比较。结果：我们将21例从RHs转移的患者与21例在LTH治疗的患者进行了匹配。RH组和LTH组的损伤类型（钝性创伤：81% vs 76%， p = 0.71）和损伤严重程度评分（中位数34 vs 41， p = 0.37）相似。腹部并发症常见（21.4%），RH组与LTH组无显著差异（28.6% vs 14.3%, p = 0.08）。次要结局，包括死亡（14.3% vs . 28.6%, p = 0.26）、开腹时间（1.0 d vs .0 d, p = 0.25）、入住重症监护病房（95.2% vs . 81.0%, p = 0.15）和住院时间（16.0 d vs . 17.0 d, p = 0.48）在RH组和LTH组之间具有可比性。结论：虽然不常见，但在RHs行DCL并不与较高的发病率或死亡率相关。应鼓励lth和RHs在某些情况下进行合作。未来的研究应侧重于确定理想的候选者、创伤系统障碍以及在农村环境中支持这种做法的方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian Journal of Surgery 医学-外科

CiteScore

3.00

自引率

8.00%

发文量

120

审稿时长

6-12 weeks

期刊介绍： The mission of CJS is to contribute to the meaningful continuing medical education of Canadian surgical specialists, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.