Influence of operative timing on perioperative outcomes of patients with the seatbelt sign

Nolan M Winicki; Isabella S Florissi; Alberto Nunez; Jeremy Santiago; Sigrid Burruss; Daniel P Srikureja

doi:10.1016/j.sopen.2023.04.005

Influence of operative timing on perioperative outcomes of patients with the seatbelt sign

Surg Open Sci. 2023 Apr 18:13:48-53. doi: 10.1016/j.sopen.2023.04.005. eCollection 2023 Jun.

Authors

Nolan M Winicki^{1

2

3}, Isabella S Florissi⁴, Alberto Nunez¹, Jeremy Santiago¹, Sigrid Burruss², Daniel P Srikureja⁵

Affiliations

¹ University of California Riverside, School of Medicine, Riverside, CA, United States of America.
² Loma Linda University, Department of Surgery, Loma Linda, CA, United States of America.
³ Laboratory of Cardiovascular Science, National Institute of Health, Baltimore, MD, United States of America.
⁴ Johns Hopkins University, School of Medicine, Baltimore, MD, United States of America.
⁵ Beacon Medical Group Trauma & Surgical Services, South Bend, IN, United States of America.

Abstract

Background: The seatbelt sign (SBS) is a pattern of bruising/contusions on the chest and abdominal wall following motor vehicle collisions. The aim of this analysis is to investigate the influence of time to surgery following identification of the SBS on perioperative outcomes.

Methods: A retrospective review of the Trauma Quality Improvement Program database from 2017 to 2019 was performed. Patients included in this retrospective analysis were involved in motor vehicle collisions, experienced blunt abdominal trauma, presented with skin abrasions/contusions in the SBS distribution, were hemodynamically stable, and underwent laparotomy. Demographics, vital signs, injury severity score, Glasgow coma scale, preoperative CT scans (P-CT), and time from presentation to surgery were recorded. Time from presentation to surgery was subdivided by data quartiles as immediate (<1.3 h), early (1.3-4 h), and delayed (>4 h). The influence of operative timing on postoperative mortality, hospital length of stay (LOS), intensive care unit (ICU) LOS, and ventilator days was assessed in multivariate analyses.

Results: A total of 1523 patients were included; 280 underwent immediate, 610 early, and 633 delayed surgery. Patients undergoing surgery in the early and delayed groups who received P-CT scans had shorter mean times to operation (4.52 h vs 5.24 h, p < 0.01). In multivariate analysis, patients who underwent delayed surgery stayed in the hospital 2.5 days longer (p < 0.001), spent 2.8 additional days in the ICU (p < 0.001), and spent 3.75 additional days on a ventilator (p < 0.001) than patients who received early surgery. Within the early and delayed surgical groups, P-CT was associated with lower mortality (OR 0.46 95 % CI 0.24-0.88, p < 0.01) in multivariate analysis.

Conclusions: Early surgical intervention was associated with improved patient outcomes by reducing hospital and ICU LOS and ventilator days. Conducting P-CT reduced the time to surgery and mortality. Utilization of P-CT for screening hemodynamically stable patients with the SBS upon admission may expedite identification of the potential need for surgical management of abdominal injury.

Keywords: Intra-abdominal injury; Laparotomy; Perioperative outcomes; Seatbelt sign.