Mortality risk in stable patients with penetrating abdominal trauma: critical timing considerations

Background: The management of penetrating abdominal trauma (PAT) remains controversial, particularly for patients with stable hemodynamics. This study evaluates the influence of timing—transportation, resuscitation, and time to abdominal surgery— on the outcomes of PAT patients with stable hemodynamics. Additionally, it investigates mortality-associated factors among non-survivors in this cohort. Methods: A retrospective analysis of the National Trauma Data Bank (2007–2015) identified PAT patients with stable hemodynamics (systolic blood pressure ≥90 mmHg) who underwent abdominal operations. Patients with unstable hemodynamics or delayed surgeries (>120 hours post-admission) were excluded. Demographics, emergency medical service (EMS) response time, emergency department (ED) duration, abbreviated injury scale (AIS) of abdomen, injury severity scores (ISS), and hollow viscus injury (HVI) presence were analyzed. Multivariate logistic regression determined mortality-associated factors. Results: Among the 31,662 PAT patients who underwent abdominal operations, 5900 patients (18.6%) had stable hemodynamics and underwent surgery more than 2 hours after ED arrival, which was the focus of this study. Among these patients, non-survivors were older, had prolonged EMS + ED times, higher abdominal AIS and ISS scores, and an increased presence of HVI. Time to surgery was not significantly associated with mortality (p = 0.450). Patients with HVI demonstrated a higher risk of mortality. Subset analyses revealed that non-survivors with HVI experienced significantly longer surgical delays compared to survivors. In contrast, no significant difference in time to abdominal surgery was observed between survivors and non-survivors among patients without HVI. Conclusions: For stable PAT patients, delayed surgery did not correlate with increased mortality. However, prolonged preoperative delays (EMS + ED) and the presence of HVI were significant risk factors for mortality. Optimizing EMS and ED workflows and prioritizing timely interventions for HVI are critical for improving outcomes.