Penetrating abdominal stab and gunshot injuries: 10-year experience of a secondary public hospital located in a suburban area with solo surgeons

OBJECTIVE: Trauma care systems are life-saving significant implementations of a country’s healthcare systems. Trauma care requires well-established trauma settings and organizations with experienced trauma teams including experienced emergency medicine, surgery and anesthesiology staff. This study aimed to investigate the outcomes of penetrating abdominal injuries treated by solo surgeons in a suburban area.
METHODS: Medical records of the patients who were admitted to the emergency department with penetrating abdominal injuries between January 2012 and December 2021 were retrospectively analyzed. Patients were evaluated based on their injury sites and treatment approaches.
RESULTS: In total, 110 patients with anterior abdominal penetrating injuries were enrolled in the study; 83 (75.4%) were stabbed and 27 (24.6%) had gunshot wounds. According to the injury site, there were 90 (81.8%) anterior; 11 (11%) right thoracoabdominal and 9 (7.2%) left thoracoabdominal injuries. Fifty-one (61.4%) stab wounds were treated with immediate laparotomy and 21 (41.1%) of these operations resulted in negative or nontherapeutic laparotomy. Also, 32 (38.6%) stab wounds were managed nonoperatively; three (9.3%) failed conservative management and received delayed laparotomy. All gunshot wounds were treated with immediate laparotomy and 14.8% resulted in either negative or nontherapeutic laparotomy. On-call surgeons were found to be more prone to perform immediate laparotomy on weekends when they were on call for 48 or 72 hours.
CONCLUSION: Being a solo surgeon may increase negative laparotomy rates of penetrating abdominal injuries. This high percentage (41.1%) of negative laparotomy rates can be reduced by establishing well-organized trauma teams.

Penetran abdominal býçaklanma ve ateþli silah yaralanmalarý: Ýkinci basamak devlet hastanesinde solo cerrahlarýn 10 yýllýk deneyimi

Giriþ: Travma yönetimi, bir ülkenin saðlýk sistemlerinin hayat kurtaran önemli uygulamalarýndan biridir. Travma bakýmý, alt yapýsý uygun ve deneyimli acil týp, cerrahi ve anesteziyoloji personeli dahil olmak üzere deneyimli ekiplerin organizasyonuyla baþýrýlý sonuçlar verir. Bu çalýþmada, ikinci basamak devlet hastanesinde solo cerrahlar tarafýndan tedavi edilen býçaklanma ve ateþli silah yaralanmalarýnýn sonuçlarýnýn deðerlendirilmesi hedeflenmiþtir.
Yöntem: Ocak 2012 ile Aralýk 2021 tarihleri arasýnda acil servise abdominal penetran yaralanma ile baþvuran hastalarýn týbbi kayýtlarý retrospektif olarak incelendi. Hastalar yaralanma bölgeleri ve tedavi yaklaþýmlarýna göre deðerlendirildi.
Bulgular: Toplamda, anterior karýn penetran yaralanmasý olan 110 hasta çalýþmaya alýndý; 83'ü (%75,4) býçaklanma, 27'si (%24,6) ateþli silah yaralanmasýydý. Yaralanma yerine göre 90 (%81.8) anterior; 11 (%11) sað torakoabdominal ve 9 (%7,2) sol torakoabdominal yaralanma idi. Elli bir (%61,4) býçaklanma acil laparotomi ile tedavi edildi ve bu ameliyatlarýn 21'i (%41,1) negatif veya terapötik olmayan laparotomi ile sonuçlandý. Ayrýca 32 (%38.6) býçaklanma konservatif olarak tedavi edildi; üçü (%9.3) konservatif tedavide baþarýsýz oldu ve gecikmiþ laparotomi yapýldý. Acil laparotomi ile tedavi edilen tüm ateþli silah yaralanmalarý ve %14.8'i ya negatif ya da terapötik olmayan laparotomi ile sonuçlandý. Nöbetçi cerrahlarýn, 48 veya 72 saat nöbette olduklarý hafta sonlarýnda acil laparotomi yapmaya daha yatkýn olduklarý bulundu.
Sonuç: Solo cerrah olmak penetran karýn yaralanmalarýnda negatif laparotomi oranlarýný artýrabilir. Negatif laparotomi oranlarýnýn bu yüksek yüzdesi (%41,1) iyi organize edilmiþ travma ekipleri kurularak azaltýlabilir. (NCI-2023-5-12)