The Distinct and Secondary Harmful Effect of Pelvic and Extremity Injury on the Outcome of Laparotomy for Trauma Rebecca A. Prince, M.D., M.Sc,* Christopher J. Hoffman, M.D., M.P.H.,* Richard M. Scanlan, M.D.,† and John C. Mayberry, M.D.* ,1 *Department of Surgery, Trauma/Critical Care Section and †Department of Pathology, Blood Transfusion Service, Oregon Health & Science University, Portland, Oregon Submitted for publication July 16, 2003 Hypothesis. Extra-abdominal injury negatively af- fects the outcome of abdominal injury following trauma laparotomy. Design. Retrospective review of 920 consecutive pa- tients receiving laparotomy for trauma who survived more than 24 h between January 1989 and May 1998 at a Level 1 trauma center. Major abdominal complications (MAC) were defined as: abdominal compartment syn- drome (ACS), abscess/peritonitis, enterocutaneous fis- tula, necrotizing fasciitis, and necrotizing pancreatitis. Methods. Univariant and multivariant logistic re- gression were used to identify predictors of MAC. Results. Sixty-nine patients (7.5%) developed one or more MAC. Patients who developed MAC had higher injury severity scores (ISS), abdominal trauma indices (ATI), and blood transfusions in the first 24 h (PRCs) than patients who did not develop MAC. Patients with MAC were more likely to have suffered a thoracic or pelvic injury with an abbreviated injury scale (AIS) >3 and were more likely to have received an extremity injury (AIS >3) operation than patients without MAC. Independent predictors of MAC in multivariant anal- ysis included colon injury (AIS >3) [odds ratio (OR)  3.1, 95% confidence interval (CI) 1.5– 6.3)], pelvic injury (AIS >3) or operation for extremity injury (AIS >3) [OR 2.9, 95% CI 1.5–5.3], and ATI (OR  1.03 for each 10 unit increase in ATI, 95% CI 1.02–1.05). PRCs did not independently predict MAC. Conclusion. The outcome of laparotomy for trauma (both blunt and penetrating) is negatively affected by a severe pelvic injury or a severe extremity injury operation independent of initial hemorrhage and ab- dominal injury severity. © 2004 Elsevier Inc. All rights reserved. Key Words: trauma; abdomen; complications; extra- abdominal injury. INTRODUCTION Trauma patients who undergo an emergent or ur- gent laparotomy arrive at the hospital on short notice and often are taken to the operating room while a complete evaluation is still in progress. Operative and postoperative management of these patients may be complicated by injuries affecting multiple organs and body regions—including extra-abdominal injuries re- quiring aggressive treatment before, during, and after laparotomy. Both blunt and penetrating trauma pa- tients can manifest significant hemorrhage and tissue destruction at multiple sites and are therefore at risk for additive hemodynamic and inflammatory insults. The secondary insult effect of an extra-cranial injury on brain injury is well described [1, 2], but very little has been written on the secondary effect that an extra- abdominal injury may have on abdominal injury. We hypothesized that patients requiring a laparotomy for trauma who had significant extra-abdominal injuries would be at higher risk to develop major abdominal complications (MAC) than patients without extra- abdominal injuries. METHODS All patients receiving laparotomy for trauma in the time period January 1, 1989 through May 31, 1998 at the Oregon Health & Sciences University (OHSU) level 1 trauma center were identified in a two-step process. We first queried the OHSU Trauma Registry to obtain all injured patients with ICD-9 procedure codes related to an abdominal operation. Each patient’s registry profile was then printed and reviewed to identify those patients whose laparotomy was performed for injury or suspicion of an injury within 5 days of admission. Negative and nontherapeutic laparotomies were in- 1 To whom correspondence and reprint requests should be ad- dressed at Oregon Health & Science University, 3181 SW Sam Jack- son Park Road L223A, Portland, OR 97239. E-mail: mayberrj@ohsu.edu. Journal of Surgical Research 124, 3– 8 (2005) doi:10.1016/j.jss.2004.09.016 3 0022-4804/05 $30.00 © 2004 Elsevier Inc. All rights reserved.