Selective non-operative management of abdominal gunshot wounds at Groote Schuur Hospital : a cohort study of clinical outcomes and financial costs

[Background] Selective non-operative management (SNOM) of abdominal gunshot wounds is a practice that is becoming more common in major urban trauma centres. With increasing levels of violence, SNOM offers a useful method for managing injured patients. Historically, operative management of blunt and penetrating wounds to the abdomen has been the standard of care. This has changed over the past several decades with the advancement of imaging techniques and the realization that many penetrating wounds do not require surgical intervention. However, reticence towards SNOM for the management of abdominal gunshot wounds has remained because of the high probability of visceral organ damage. This study contributes to the growing field of violence prevention and trauma systems management by examining the use ofSNOM for abdominal gunshot wounds. We examined the hypothesis that SNOM does not increase morbidity or mortality in patients and decreases total hospital costs. [Methods] A retrospective cohort study of257 consecutive patients admitted to a level I trauma centre in South Africa for the management of abdominal gunshot wounds over a one year period from I April 2004 to 31 March 2005 was performed. [Results] Ninety-three of257 (36%) of abdominal gunshot wound victims were nonoperatively managed. Of these 93 patients, 5 (5%) later required surgery and were converted to a delayed laparotomy. Of the 164 patients who were treated. with immediate laparotomy, 10 (6%) underwent non-therapeutic laparotomies. There were no deaths within the cohort of patients that were managed non-operatively during the hospital stay compared to 9 deaths in the group of surgically managed patients (p=0.03). On multivariate analysis, there was no statistically significant difference in overall complication rate during the hospital stay between patients who were treated non-operatively compared to those who were treated operatively after adjusting for injury severity (HR 1.25, 95% CI 0.61-2.55). There was also no statistically significant difference in total hospital cost between the two groups (HR 0.40, 95% CI 0.15-1.08). [Conclusion] This study has policy implications for violence prevention and health systems management. It suggests that SNOM can be successfully used in less severely injured abdominal gunshot wounds. The use of SNOM does not increase morbidity or mortality rates during the hospital stay. Thus, it can also be used effectively as a part of cost-containment policies geared towards the redistribution of human and financial resources in the trauma centre.

Grantor dc:publisher.institution

Department of Public Health and Family Medicine

Year dc:date.issued

2009

Author dc:creator

• Kim, Rebecca Y

Advisors dc:contributor.advisor

• Myer, Landon
• Navsaria, H

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/11427/9319

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/9319