Indications, risk factors, and clinical outcomes of relaparotomy after abdominal trauma surgery.

Mehmet Bahadır Demir, Suleyman Utku Celik, Sahin Kaymak
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Abstract

Background: Relaparotomy following abdominal trauma surgery is a critical intervention associated with significant morbidity and mortality. However, data on relaparotomy in trauma patients remain limited. This study aimed to evaluate the impact of relaparotomy-related factors on prognosis in patients undergoing relaparotomy after abdominal trauma surgery.

Methods: This retrospective study analyzed adult patients who underwent relaparotomy following abdominal trauma surgery at a single center between December 2016 and December 2022. Demographic characteristics, trauma-related features, and perioperative clinical findings were recorded. Statistical analyses were conducted to identify factors associated with in-hospital mortality.

Results: Among 300 patients who underwent abdominal trauma surgery, 106 (35.3%) required relaparotomy. The in-hospital mortality rate was 9.4%. Major indications for relaparotomy included hemorrhage control, hemodynamic instability, and intestinal leaks. Factors significantly associated with increased mortality included age ≥50 years (p=0.020), female sex (p=0.031), blunt trauma (p=0.020), multiple relaparotomies (p=0.023), active hemorrhage during relaparotomy (p<0.001), and fresh frozen plasma transfusion (p=0.046). Additionally, non-survivors demonstrated significantly lower blood pressure (p<0.001) and higher heart rates (p<0.001). They also presented with decreased levels of hemoglobin (p=0.015), platelet counts (p=0.001), and albumin (p<0.001), along with elevated international normalized ratio (INR) (p<0.001) and lactate levels (p<0.001).

Conclusion: This study highlights key factors associated with mortality in patients undergoing relaparotomy after abdominal trauma surgery. Early recognition and optimization of risk factors, along with the management of active hemorrhage, careful monitoring of vital signs and laboratory parameters, and special attention to high-risk groups such as older patients and those with blunt trauma, may improve outcomes in this vulnerable population.

腹部创伤手术后再开腹手术的适应症、危险因素和临床结果。
背景:腹部创伤手术后再开腹术是一项重要的干预措施,与显著的发病率和死亡率相关。然而,关于创伤患者剖腹手术的数据仍然有限。本研究旨在探讨腹部外伤术后再开腹手术相关因素对患者预后的影响。方法:本回顾性研究分析了2016年12月至2022年12月在单一中心接受腹部创伤手术后再开腹手术的成年患者。记录人口学特征、创伤相关特征和围手术期临床表现。进行统计分析以确定与住院死亡率相关的因素。结果:300例腹部外伤患者中,106例(35.3%)需要开腹手术。住院死亡率为9.4%。再开腹手术的主要适应症包括出血控制、血流动力学不稳定和肠漏。与死亡率增加显著相关的因素包括年龄≥50岁(p=0.020)、女性(p=0.031)、钝性创伤(p=0.020)、多次再开腹手术(p=0.023)、再开腹手术时活动性出血(p)。结论:本研究突出了腹部创伤手术后再开腹手术患者死亡率相关的关键因素。早期识别和优化危险因素,同时管理活动性出血,仔细监测生命体征和实验室参数,并特别关注高危人群,如老年患者和钝性创伤患者,可能会改善这一弱势群体的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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