When it comes to a gunshot or stab wound in the stomach, surgeons will almost reflexively open up a patient’s abdomen to look for damage.
But that’s starting to change as doctors rethink how best to manage trauma cases.
A team of researchers pored over the National Trauma Data Bank and examined more than 25,000 cases of penetrating injuries to the abdomen (about 12,000 gunshot cases and 13,000 stabbings) in the U.S. between 2002 and 2008.
They found that more hospitals are trying a no-surgery option when possible. That’s helping to reduce the number of unnecessary operations, prevent complications and save money, according to Dr. Adil Haider, senior author from the Johns Hopkins University School of Medicine.
“Patients are coming in to hospitals and recovering without any surgical intervention,” Haider tells Shots. “Across the country, more and more people are doing non-operative management.” The findings appear in the British Journal of Surgery.
The key is figuring out which patients are OK to treat without surgery.
The first question: Is the patient stable? “If they aren’t, then they will probably move straight to surgery.” Dr. Amy Rushing, a co-author of the study, tells Shots. “If the answer is yes, now you have time to do diagnostic testing.”
Diagnostic testing is fancy lingo for a more thorough physical examination, some blood work and, often, a CT scan — all tests to better determine if an operation is needed.
If doctors deem surgery unnecessary, patients get monitored by a trained team while they heal, Rushing says. If the patient’s condition deteriorates, Rushing says emergency surgeons are ready to jump in and help.
About 22 percent of gunshot-wound patients and 34 percent of stab-wound patients between 2002 and 2008 were treated without immediate surgery, researchers found.
“The length of stay in a hospital for patients drops significantly, as well,” Haider says of the treatment.
In the early days of medicine, the lack of infection control prevented exploratory surgery for traumatic wounds. The idea that injured people needed surgery just to take a look inside stems from World War I. That’s when exploratory surgery became the standard for care and, in turn, led to better survival rates, the researchers say.
Events in South Africa helped push the pendulum back, Haider says. When riots over apartheid erupted in Johannesburg, hospitals were flooded with patients who had been stabbed. Doctors operated first on the patients who looked closest to death. By the time they got to the healthiest-looking individual, that patient often would report feeling well enough to walk out, according to Haider. That got doctors thinking about nonsurgical options for the treatment of stabbing victims.
Haider and Rushing caution that forgoing surgery in some cases isn’t easy to do. Hospitals and doctors need to have a well-thought-out plan and make sure everybody is ready. “If it fails, it’s a big price to pay,” Haider says. “The consequences are dire.”