Postoperative mortality following civilian firearms injury during war: A retrospective cohort study

Öz

Background: This study aims to identify factors affecting mortality following surgery for civilian firearms injuries using surgical classification as a surrogate marker of injury severity.

Methods: This was a retrospective study of patients who underwent surgery at a tertiary university hospital in Turkey between 2011 and 2014. All patients had sustained firearms injury and had an American Society of Anesthesiologists score of I-II. A grading system defined by the Communiqué on Health Practices in Turkey was used based on the surgery type and anesthetic procedure to determine the severity of injury and its relation with patient outcome (survival or death).

Results: The median duration of hospital stay of patients who were discharged post healing was significantly longer than those who died [12 (0–559).vs 7.5 (0–468) days, respectively]. Overall mortality was 11.3%; however, the mortality of patients was 8.1%, 40.3%, and 40.3% in groups A2, C, and D, respectively. Healing in groups A2, C, and D was 2.4%, 54.1% and 25.8%, respectively. Independent variables affecting the coefficient of patient discharge status for sex, age, and surgical groups A2, C, and D were found to be significant.

Conclusion: There was an association between the surgical groups and the firearms injuries sustained by civilians. Moreover, the coefficients associated with surgical group in our model may help predict the mortality risk in similar populations.

Anahtar Kelimeler

• firearms injury,postoperative mortality,war njury

Savaş sırasında sivil ateşli silah yaralanmalarını takiben ortaya çıkan mortalite: Retrospektif bir kohort araştırması

Öz

Amaç: Bu çalışma savaş yaralanması nedeni ile ameliyat edilen hastalar arasında, cerrahi grupların sınıflandırmasını yaralanma şiddetinin yerine kullanarak, mortaliteyi etkileyen faktörleri tanımlamayı amaçlamaktadır.

Yöntem: Bu Türkiye’de bir üçüncü basamak üniversite hastanesinde 2011 ve 2014 yılları arasında ameliyata alınan hastalarda yapılan retrospektif bir çalışmadır. Tüm hastalar ateşli silah yaralanması nedeni ile ameliyata alınmış ve ASA skorları I–II idi. Yaralanmanın şiddetini ve hastanın son durumunu (sağ kalım veya ölüm) saptamak için cerrahinin tipi ve bununla ilişkili anestezi işlemine dayalı bir derecelendirme sistemi-Türkiye’de Sağlık Uygulamaları Tebliğinde tanımlandığı şekli ile- kullanıldı.

İstatistiksel analiz sonuçları: Şifa ile taburcu olanların hastane süreleri ölenlerden anlamlı dercede daha uzundu [medyan (min-maks.) olarak sırası ile 12 (0-559).ve 7.5(0-468) gün]. Hastalar altı kategorik cerrahi gruba (A2, A3, B, C, D, ve E) dağılmıştı. Tüm mortalite %11.3 idi ancak A2, C, ve D gruplarında hastaların sırası ile %8.1, %40.3 ve %40.3’ü, ve şifa-sağ kalım yine A2, C, D grup hastalarda sırası ile %2.4, %54.1, %25.8 oranında idi. Hastanın son durumunu etkileyen bağımsız değişkenlerin cinsiyet, yaş ve cerrahi gruplardan A2, C ve D için katsayıları anlamlı idi.

Sonuç: Cerrahi operasyon kategorileri ve sivil ateşli silah yaralanmaları arasında bir ilişki olduğu gözükmektedir, Dahası, modelimizdeki cerrahi grupları ile ilişkili katsayılar benzer populasyonlarda mortalite riskini tahmin etmeye yardımcı olabilir.

Anahtar Kelimeler

• ateşli silah yaralanması,postoperatif mortalite,savaş yaralanması

Kaynakça

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