J. G. Tyburski1,2, H. S. Dolman1,2, W. Zimmerman2, L. Hall Zimmerman2, A. E. Baylor1,2, T. T. Lavery1,2, J. Ciullo1, R. F. Wilson1,2 1Wayne State University,Surgery,Detroit, MI, USA 2Detroit Medical Center,Detroit, MI, USA
Introduction:
In patients having emergency surgery for abdominal trauma, the presence of genitourinary (GU) injury has a high incidence death and infection. The objective of this study is to evaluate the factors associated with mortality and infections in patients with emergency surgery for abdominal trauma and GU injury.
Methods:
This retrospective study evaluated patients who were admitted with abdominal trauma requiring emergency surgery at a Level 1 Trauma Center over 30 years (1980–2010). Concomitant injuries, emergency department (ED), and operating room (OR) data were evaluated. Infections evaluated were pneumonia (PNA), bacteremia (BSI), intraabdominal (IAI), urinary tract (UTI), or surgical wound (SWI).
Results:
Of 1105 patients requiring emergency surgery for abdominal trauma, 234 (21%) had GUI (kidney 170 (73%), ureter 35 (15%), and urinary bladder 44 (19%)). Patient’s mean age was 31 ± 12years with Injury Severity Score 21 ± 11 and 210 (90%) being penetrating trauma. Of 234 patients evaluated, 46 (20%) died ≤ 48 hours and 11 (5%) died later primarily due to infection (7/11, 64%). Overall mortality rate (MR) was 29% kidney, 17% ureter, and 9% urinary bladder injuries with 50/57 (88%) of all deaths having kidney injury. Major factors affecting MR were emergency/operating (ED/OR) blood transfusions and initial OR systolic blood pressure (SBP). The MR for 10+ units, 1-9 units, no transfusion were 41% (34/82), 26% (20/77), 4% (3/75), p<0.001. The MR for initial OR SBP < 70, 70-89, 90-119, 120+mmHg were 88% (23/26), 39% (11/28), 26% (16/61), 6% (7/119), p<0.001. In patients requiring nephrectomy, MR was 27/50 (54%) with 32/50 (64%) required massive transfusion. There were 157 infections in 64 of 188 patients surviving >48 hours, 34 intraabdominal, 26 wound, 42 pneumonia, 32 bacteremia, 23 urinary. The major factors affecting the infection rates (IR) were ED/OR transfusions and initial OR SBP. The IR for 10+units, 1-9 units, no transfusion were 58% (28/48), 38% (26/68), 14% (16/72), p<0.001. The IR for initial OR SBP < 90, 90-119 and 120+mmHg were 58% (14/28), 41% (20/49), and 26% (30/115), p<0.001.
Conclusion:
Genitourinary trauma in patients requiring an emergency laparotomy are associated with high mortality and morbidity. Factors associated with mortality and infections were blood transfusions and initial OR SBP.