Impact of Extremity Amputation on Combat Wounded Undergoing Exploratory Laparotomy

Background: Combat casualties with traumatic amputations (TA) and requiring laparotomy present unique clinical challenges. The purpose of this study was to determine the association of TA on blood/blood product usage, emergency department (ED) and operating room (OR) times, and mortality in those undergoing exploratory laparotomy after combat injury. Methods: A retrospective study was performed at one combat support hospital in Iraq of patients requiring exploratory laparotomy for abdominal injury. These patients were divided into two cohorts based on the presence or absence of TA. Initial vital signs, international normalization ratio, pH, blood product usage, time in ED and OR, and mortality were compared between groups. Results: We reviewed 171 consecutive laparotomies performed between September 2007 and May 2008. Twenty one were identified with TA. Presenting systolic pressure, hemoglobin, platelets, international normalization ratio, and arterial pH did not differ between groups. The TA group presented more tachycardic, received more blood/blood products in ED and OR, and were more likely to meet requirements of massive transfusion. There was no difference in mortality between groups. Time in ED was shorter and time in OR was longer for the TA cohort. Conclusion: TA with penetrating abdominal injuries are associated with increased transfusions of blood products beginning at patient arrival. Massive transfusion protocols should be activated as soon as this injury is identified. The severity of this injury pattern was only manifested by an increased heart rate at admission. TA with abdominal injury spent less time in ED and a longer time in OR; however, there was no increase in mortality.