# Association of Preoperative Imaging and Surgical Delay with Hemorrhagic Mortality in Abdominal Trauma: A Retrospective Multicenter Study

## TL;DR

This study finds that longer delays before surgery for abdominal trauma increase the risk of death from bleeding, with a sharp increase after about 90 minutes, and preoperative CT scans do not worsen outcomes when used appropriately.

## Contribution

The study identifies a critical time threshold for surgical intervention in abdominal trauma and clarifies the role of preoperative CT in influencing outcomes.

## Key findings

- Each 1-minute increase in ED-to-OR time was associated with an 1.8% higher odds of hemorrhagic death.
- A surgical delay beyond approximately 90 minutes was linked to a sharp rise in mortality risk.
- Preoperative CT scans, while causing delays, were not independently associated with increased hemorrhagic mortality when used selectively.

## Abstract

Background: Surgical delay in abdominal trauma with hemorrhage is a leading cause of preventable death, yet the precise time threshold for adverse outcomes remains uncertain. This study examined the association between emergency department (ED)-to-operating room (OR) time and hemorrhagic mortality and evaluated the impact of preoperative computed tomography (CT). Methods: We retrospectively analyzed patients ≥15 years old who underwent emergency laparotomy for abdominal trauma at two Level I trauma centers in South Korea (2016–2023). The primary outcome was hemorrhagic death, adjudicated by a multidisciplinary review panel. Multivariable and segmented logistic regression was used to assess the association between ED-to-OR time and mortality. The effect of preoperative CT was evaluated using inverse probability of treatment weighting (IPTW). Results: Among 414 patients, 71 (17.1%) died from hemorrhage. Each 1-min increase in ED-to-OR time was associated with 1.8% higher odds of hemorrhagic death (adjusted OR = 1.018; 95% CI, 1.007–1.030). Segmented regression identified a changepoint at 91 min (bootstrap 95% CI, 62.0–97.6), beyond which mortality risk rose sharply. Preoperative CT was performed in 27.5% of patients and was associated with a mean surgical delay of over 30 min. After IPTW adjustment, CT use was not significantly associated with hemorrhagic death (14.3% vs. 10.3%, p = 0.542). Conclusions: Longer ED-to-OR intervals were associated with increased hemorrhagic mortality, particularly beyond approximately 90 min. Although preoperative CT contributed to procedural delay, it was not independently associated with worse outcomes when selectively used in stable patients. These findings represent observational associations in current practice rather than causal effects, underscoring the importance of minimizing surgical delay while cautiously considering CT in appropriate patients.