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

Yıl 2019, Cilt: 26 Sayı: 2, 131 - 140, 01.06.2019

Menekşe Okşar , Cagla Akkurt Selim Turhanoglu

https://doi.org/10.17343/sdutfd.417891

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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