Postoperative outcomes in earthquake victims with orthopedic trauma: a focus on mortality and dialysis needs.

Abstract

Background: This study aims to identify the factors associated with postoperative mortality and the need for dialysis in earthquake survivors presenting with isolated orthopedic injuries, with particular emphasis on crush syndrome and its clinical consequences.

Methods: This single-center retrospective study included patients who sustained limb or vertebral injuries during the February 6, 2023, earthquake and underwent surgical intervention following transfer from the disaster zone. Exclusion criteria comprised non-earthquake-related injuries, pre-existing chronic renal or liver failure, prior amputations unrelated to the earthquake, concomitant head, thoracic, or abdominal injuries, pregnancy, and cases with incomplete data. Data on injury location, anesthesia technique, surgical procedures, dialysis requirements, and postoperative outcomes were collected. Surgical interventions were classified into four categories: fasciotomy, amputation, debridement, and osteosynthesis. Intergroup comparisons were conducted by Kruskal-Wallis test. The backward stepwise approach for regression model was employed to minimize suppressor effects-where a predictor's significance is contingent on the presence of another variable-and to reduce the risk of type II errors, thereby ensuring the identification of significant predictors. Analyses were performed using Statistical Package for Social Sciences version 20 program.

Results: A total of 561 patients were included in this study. Patients had several injuries as follows: upper extremity in 123 patients (19.6%), thigh in 151 (24.1%), calf and foot in 279 (44.6%) and vertebral column in 72 (11.5%). The findings showed that patients with thigh injury had the highest mortality rate, which was 55% (p = 0.012). A sum of 187 patients (33.3%) were diagnosed as crush syndrome. Dialysis requirement was observed in 25.1% of patients with crush syndrome, highlighting its significant impact on mortality (p = 0.017). A multivariate linear backward regression analysis showed that hematocrit, platelet count, alanine transaminase, and time to admission were the significant predictors for mortality (ß=-0.113, p = 0.039; ß=-0.133, p = 0.007; ß=0.196, p < 0.05; ß=0.158, p = 0.001, respectively).

Conclusions: It can be concluded that above-knee injuries and the requirement for dialysis are significant predictors of increased mortality. Early diagnosis and timely therapeutic intervention in these patients are critical to improving clinical outcomes. Furthermore, delayed hospital admission is associated with higher mortality rates, highlighting the importance of rapid medical response and efficient triage in disaster scenarios to optimize patient survival.

Clinical trial number: Not applicable.