Patterns of negative trauma laparotomy worldwide: a sub-analysis of a global dataset

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PURPOSE: Trauma remains a major contributor to global disability. While the trauma laparotomy can be a life-saving procedure in abdominal injury, a select proportion are performed with no pathology identified intra-operatively, potentially exposing patients to unnecessary morbidity. We aimed to assess the global prevalence of negative laparotomy and identify any influencing factors at both the patient- and system-level. METHODS: This was a secondary analysis of the GOAL-Trauma study, a multicentre prospective international observational study on trauma laparotomy patients, conducted from April to December 2024. We defined a negative laparotomy as where no intra-abdominal injuries were identified during the index operation. A multivariable logistic regression was performed to identify predictive factors for a negative laparotomy. RESULTS: Of the 1769 patients included, 128 patients (7.2%) underwent a negative laparotomy. Regression analysis demonstrated that a penetrating mechanism of injury (OR 2.37, CI:1.53-3.69, p < 0.001) and a lower grade of surgeon (surgical registrar relative to consultant - OR 2.91, CI:1.90-4.47, p < 0.001) were independent predictors for negative laparotomy. Neither human development index nor hospital resource level impacted negative laparotomy rates. CONCLUSION: One in every fourteen trauma laparotomies performed in our global cohort was negative, with injury type and surgeon experience having a significant deterministic role. As trauma systems develop globally, recognition in the value of both training and a structured assessment pathway is paramount. The rate of negative trauma laparotomy, either institutionally or regionally, may act as a useful benchmark of trauma system performance and warrants further exploration.

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