Two Decades of Evolution in Abdominal Trauma Surgery: Trends, Outcomes, and Implications From an Australian Level 1 Trauma Centre

ABSTRACT Background Advances in imaging, non‐operative management, and endovascular techniques have reshaped abdominal trauma care, but their impact on operative trends in blunt‐dominant Australian trauma systems is incompletely described. Aims To describe temporal trends in operative and minimally invasive management of abdominal trauma at an Australian Level 1 trauma centre, and to discuss their implications. Methods A retrospective study of the Alfred Health Trauma Registry (2001–2024) identified adult major trauma (MT) patients (ISS > 12) undergoing emergency laparotomy, laparoscopy, or solid‐organ embolisation within 24 h of admission. Temporal trends were assessed using linear regression and offset Poisson models. Sensitivity analyses used abdominal AIS ≥ 2 as the denominator. Results Among 25 497 major trauma patients, 1330 (5.2%) underwent laparotomy, 107 (0.4%) laparoscopy, and 417 (1.6%) embolisation. Annual major trauma presentations increased from 643 to 1498, while the number of patients with abdominal AIS ≥ 2 also rose. Laparotomy rates declined significantly over time, from 10.7% to 2.7% of major trauma admissions (R 2 = 0.80; p < 0.01), with the decline persisting when abdominal AIS ≥ 2 was used as the denominator. Embolisation increased significantly, whereas laparoscopy volumes rose numerically but did not demonstrate a consistent statistically significant temporal increase. Conclusion Emergency trauma laparotomies have declined despite increasing trauma volume and abdominal injury burden, consistent with greater use of selective non‐operative and endovascular strategies. These changes have implications for maintaining operative readiness within contemporary multidisciplinary trauma systems.