Emergency laparotomies in trauma management: a six-year case series

Emergency laparotomies, defined as procedures performed within 24 hours of hospital admission following trauma, are associated with considerable mortality. Notably, blunt abdominal injuries carry higher mortality rates compared to penetrating injuries. The primary aim of this study was to evaluate whether emergency trauma laparotomies performed at our Level I trauma center—serving a population with a comparatively higher proportion of penetrating injuries—achieve outcomes comparable to contemporary benchmark data. We conducted a retrospective analysis of patients treated between 2019 and 2024 in the surgical trauma bay at Asklepios Klinik St. Georg, Hamburg, who underwent laparotomy within 24 hours of hospital admission. Mortality was defined as survival until hospital discharge. Functional outcomes were assessed using the Glasgow Outcome Scale (GOS). A total of 64 patients were included. Of these, 39.0% sustained penetrating trauma and 61.0% underwent laparotomy following blunt trauma. Among penetrating injuries, stab wounds predominated (92.0%), while 8.0% resulted from gunshot wounds. The most frequent mechanisms of blunt trauma were traffic accidents (30.8%) and falls from height (25.6%). Overall survival was 71.9% (mortality 20.0% for penetrating trauma; 33.3% for blunt trauma). Prehospital cardiopulmonary resuscitation (CPR) had been performed in 18.8% of patients. The majority of incidents (57.8%) occurred during daytime hours (08:00–20:00).Survivors received significantly fewer units of packed red blood cells during resuscitation (3.1 vs. 12.4; p < 0.0001) and were more frequently operated on in the central operating room under cardiopulmonary stability. The mean GOS among survivors was 4.6 ± 0.8. The overall Injury Severity Score (ISS) averaged 34.5, while survivors had a significantly lower mean ISS of 17.9 (p < 0.0001). Emergency laparotomy remains a valuable treatment option that offers a substantial chance of survival for haemodynamically unstable patients with both blunt and penetrating trauma. A structured trauma care, rapid recognition of physiologic extremis, and timely operative intervention within an organized Level I trauma system can achieve survival outcomes comparable to contemporary benchmark data, even in a severely injured cohort.