Factors affecting mortality in patients undergoing surgical procedures after the 2023 Türkiye earthquake.

Abstract

Background: On February 6, 2023, two devastating earthquakes struck southeastern Türkiye and northern Syria, significantly affecting 11 provinces in Türkiye and causing widespread destruction. The aim of this study is to investigate the factors influencing mortality among patients who underwent surgical procedures at a regional tertiary care center following the earthquakes.

Methods: A total of 4,622 earthquake victims were admitted to our hospital. Of these, 637 patients who required surgical interventions were included in the study. Patient records were retrospectively analyzed. Data collected included demographic characteristics, laboratory findings, types of injuries, surgical procedures performed, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, length of stay (LOS) in the intensive care unit (ICU), and mortality outcomes. Extrication time and transport time to the hospital were obtained from prehospital emergency ambulance records.

Results: Among the patients, 159 had been trapped under debris and later extricated. The mean APACHE II score was 29.6 and the overall mortality rate was 3.9%. Crush syndrome and burn injuries were significant predictors of mortality. Factors associated with mortality included the use of hemodynamic support drugs, direct ICU admission upon arrival, male sex, prolonged extrication and transport times, higher APACHE II scores, elevated levels of potassium, phosphorus, creatine kinase, blood urea nitrogen, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, and acidosis on admission. Extrication time demonstrated strong pre-dictive value for mortality (area under the curve [AUC]=0.895). The optimal cut-off point was identified as 21 hours, with a sensitivity of 78.9% and specificity of 86.4%.

Conclusion: Extrication time from entrapment under debris is one of the most important factors predicting mortality in earthquake victims. A rescue period of 21 hours is critical for survival. Early rescue from debris and rapid transport to a medical facility are essential for improving survival outcomes in earthquake victims.