Effects of moving emergency trauma laparotomies from the ED to a dedicated OR

Introduction: The trauma room at Oslo University Hospital- Ulleval is fully equipped for major damage control procedures, in order to minimize delay to surgery. Since 2006, patients in need of immediate laparotomy have increasingly been transferred to a dedicated trauma operating room (OR). We wanted to determine the decrease in number of procedures performed in the emergency department (ED), the effect on time from admission to laparotomy, the effect on non-therapeutic laparotomies, and finally to determine whether such a change could be undertaken without an increase in mortality. Methods: Retrospective evaluation of haemodynamically unstable trauma patients undergoing laparotomy during the period 2002-2009. Based on time for protocol change Period 1 was defined as 2002-2006 and Period 2 as 2007-2009. Significance was set at p < 0.05. Results: A total of 167 consecutive patients were included; 103 patients from Period 1 and 64 from Period 2. We found a 42% decrease in ED laparotomies (p < 0.001). Median time to laparotomy increased from 24.0 to 34.0 minutes from Period 1 to Period 2 (p = 0.029). Crude mortality fell from 57% to 39%. The proportion of non-therapeutic laparotomies in the OR tended to be lower over the whole study period. Conclusion: Moving this cohort of haemodynamically compromised trauma patients in need of emergency laparotomy out of the ED to a dedicated OR resulted in longer median time to laparotomy, but did not increase mortality.