Reduce Abdominal Trauma Mortality by 60% with Timely Surgery

Mortality after emergency abdominal surgery is more than three times higher in the least developed countries compared to the most developed. Yet among those who undergo surgery, injuries tend to be less severe—raising concerns that those most critically injured are not even reaching the operating theater.

A study published in The Lancet Global Health has revealed stark global inequalities in survival after emergency abdominal surgery for traumatic injuries. The research found that patients in the world's least developed countries face a substantially higher risk of dying within 30 days of surgery than those in the most developed nations, as ranked by the United Nations Human Development Index (HDI).

Although overall mortality rates appeared similar across settings at 11%, risk-adjusted analysis showed that patients in the lowest-HDI countries faced more than three times the risk of death compared with those in the highest-HDI group, while the risk in middle-HDI countries was nearly double.

The Global Outcomes After Laparotomy for Trauma (GOAL-Trauma) study was led by the University of Cambridge and carried out by a global network of collaborators. It analyzed data from 1,769 patients treated in 187 hospitals across 51 countries, ranging from conflict-affected areas such as the Occupied Palestinian Territories, Ukraine, and Sudan to well-resourced trauma centers in Europe and the United States.

All patients had undergone a trauma laparotomy—emergency surgery to repair internal abdominal injuries—as a result of incidents such as road traffic accidents, stabbings, or gunshot wounds.

Among patients who underwent surgery, those in low-HDI countries typically had less severe injuries than those in higher-ranked countries. This suggests that the most critically injured may die before reaching hospital, or that some life-threatening injuries are missed on arrival.

"Our findings point to a survival gap that begins before patients even reach the operating theater," said lead author Dr. Michael Bath from Cambridge's Department of Engineering.

"This may be because the most seriously injured die before they can access life-saving care, or because limitations in diagnosis mean their injuries go undetected."

The researchers also found wide disparities in hospital care. For example, access to CT scans before surgery—a critical tool for diagnosing internal injuries—was available in over three-quarters of patients in the more developed settings, but in fewer than one-quarter in the lowest-ranked group.

The researchers say that addressing this survival gap will take more than simply faster transport or greater access to diagnostic tools such as CT scans. They call for coordinated improvements across the entire trauma pathway—from the moment of injury to full recovery—to ensure critically injured patients receive the care they need.

"The GOAL-Trauma study provides for the first time comparable global data on laparotomy for trauma, revealing that similar mortality rates can mask profound inequalities in care pathways," said co-author Dr. Daniel U. Baderhabusha of Hôpital de Kyeshero in the Democratic Republic of Congo.

"This information will help design more equitable trauma systems that are better adapted to local realities. It paves the way for strategies that can offer every patient, wherever they live, the best chance of survival and recovery."

"The GOAL-Trauma study is one of the biggest global studies of trauma care yet published," said senior author Dr. Tom Bashford from Cambridge's Department of Engineering and Cambridge University Hospitals Foundation Trust.

"It represents a huge effort by a team of partners from across the world, some of whom are practicing in the most extreme conditions imaginable and yet still recognize the importance of contributing to international research."