Exploratory surgery isn't necessary on most abdominal gunshot and stabbing victims, according to a new study from Johns Hopkins.
Surgery increases the risk of complications, researchers said.
“Managing gunshot and stab wounds without exploratory surgery prevents complications, saves money and keeps 80 percent of patients from getting operations that end up being unnecessary,” said trauma surgeon Dr. Adil H. Haider, an associate professor of surgery, anesthesiology and critical care medicine and senior author of the study, in a statement.
Still, he said of the findings in the study, published in BJS, the British Journal of Surgery, “Not every hospital should pursue this course because if physicians make a mistake, the patient pays. It’s not a slam-dunk decision.”
Mandatory exploratory surgery had been the standard of care since World War I as doctors believed they needed to ensure there was no intestinal injury or bleeding. More recently, doctors have used diagnostic imaging and careful monitoring, said Haider, who study team included researchers from Aga Khan University in Karachi, Pakistan.
They at records from almost 26,000 truama center patients in the U.S. National Trauma Data Bank from 2002 to 2008. About 22 percent of gunshot victims and a third of stabbing victims did not have immediate surgery in the beginning and the number rose over the study period. The number of negative or unnecessary abdominal operations decreased during the same time.
Some patients did end up needing surgery, and they were 4.5 times more likely to die than those successfully managed without surgery. It's unclear if they would have died even with immediate surgery.
Haider says staffs that want to move more in the watchful waiting direction should ensure there is a well-staffed intensive care unit and in-house surgeons at the ready.