Impact of Genitourinary Injuries on Patients Requiring an Emergency Laparotomy for Trauma.

Autor:	Zimmerman WB; Urology, Michigan State University, East Lansing, USA., Baylor AE 3rd; The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA., Hall Zimmerman L; Department of Pharmaceutical Services, Beaumont Health, Royal Oak, USA., Dolman H; The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA., Ciullo JR; The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA., Dornbush J; The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA., Isaacson AR; The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA., Mansour R; The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA., Wilson RF; The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA., Tyburski JG; The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2020 Jan 31; Vol. 12 (1), pp. e6826. Date of Electronic Publication: 2020 Jan 31.
DOI:	10.7759/cureus.6826
Abstrakt:	Introduction In patients having emergency abdominal surgery for trauma, the presence of urologic injury tends to increase mortality and morbidity. Methods This retrospective study evaluated patients requiring emergency surgery for abdominal trauma at a Level 1 Trauma Center over 30 years (1980-2010). Special attention was given to patients with concomitant genitourinary (GU) injuries. Results Of 1105 patients requiring an emergency laparotomy for trauma, 242 (22%) had urologic injuries including kidney 178 (16%), ureter 47 (4%), and bladder 46 (4%). Of the 242 patients, 50 (20%) died early (<48 hours) and 13 (5%) died later, primarily due to infection. A concept of "seven deadly signs" of hypoperfusion was developed. In patients with GU injuries, the presence of any deadly sign of hypoperfusion increased the mortality rate from 4% (6/152) to 63% (56/90), p<0.001. Of the 53 patients having a nephrectomy, 36 (68%) had one or more deadly signs and 27 (75%) died. Of 17 without deadly signs, only 2 (12%) died (p=0.001). Of 167 GU patients receiving blood, 59 (35%) developed infection vs 3/75(4%) in those receiving no blood (p<0.001). Conclusions The presence of deadly signs of severe injury and hypoperfusion on admission was the major factor determining mortality. With a severely injured kidney plus any deadly signs of hypoperfusion, special efforts should be made to avoid a nephrectomy. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2020, Zimmerman et al.)
Databáze:	MEDLINE
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