Risk factors for mortality in blunt abdominal trauma with surgical approach / Fatores de risco para óbito no trauma abdominal fechado com abordagem cirúrgica

ABSTRACTObjective:identify risk factors for mortality in patients who underwent laparotomy after blunt abdominal trauma.Methods:retrospective study, case-control, which were reviewed medical records of blunt trauma victims patients undergoing laparotomy, from March 2013 to January 2015, and compared the result of the deaths group with the group healed.Results:of 86 patients, 63% were healed, 36% died, and one patient was excluded from the study. Both groups had similar epidemiology and trauma mechanism, predominantly young adults males, automobilistic accident. Most cases that evolved to death had hemodynamic instability as laparotomy indication - 61% against 38% in the other group (p=0.02). The presence of solid organ injury was larger in the group of deaths - 80% versus 48% (p=0.001) and 61% of them had other associated abdominal injury compared to 25% in the other group (p=0.01). Of the patients who died 96% had other serious injuries associated (p=0.0003). Patients requiring damage control surgery had a higher mortality rate (p=0.0099). Only one of 18 patients with isolated hollow organ lesion evolved to death (p=0.0001). The mean injury score of TRISS of cured (91.70%) was significantly higher than that of deaths (46.3%) (p=0.002).Conclusion:the risk factors for mortality were hemodynamic instability as an indication for laparotomy, presence of solid organ injury, multiple intra-abdominal injuries, need for damage control surgery, serious injury association and low index of trauma score.

RESUMOObjetivo:identificar fatores de risco para óbito em pacientes submetidos à laparotomia exploradora após trauma abdominal contuso.Métodos:estudo retrospectivo, caso-controle, no qual foram revisados prontuários dos pacientes vítimas de trauma contuso submetidos à laparotomia. Foram avaliados: variáveis epidemiológicas, mecanismo de trauma, lesões anatômicas das vísceras abdominais, lesões associadas, necessidade de operação para controle de danos reoperação e desfecho.Resultados:dos 86 pacientes, 63% foram curados, 36% foram a óbito e um paciente foi excluído do estudo. Ambos os grupos possuíam epidemiologia e mecanismo de trauma semelhantes, predominantemente adultos jovens do sexo masculino, vítimas de acidente automobilístico. A maioria dos casos que evoluíram a óbito teve instabilidade hemodinâmica como indicação de laparotomia - 61% contra 38% do outro grupo. A presença de lesão de víscera maciça foi maior no grupo óbitos - 80% vs. 48%, e 61% destes tinham outra lesão abdominal associada contra 25% dos curados. Dos pacientes que faleceram, 96% apresentavam lesões graves associadas. Pacientes que necessitaram de cirurgia de controle de danos tiveram maior taxa de mortalidade. Apenas um de 18 pacientes com lesão de víscera oca isolada evoluiu a óbito. A média do escore de trauma TRISS dos curados (91,7%) foi significativamente maior do que a dos óbitos (46,3%).Conclusão:os fatores de risco para óbito encontrados para vítimas de trauma abdominal fechado que necessitam de laparotomia exploradora são: instabilidade hemodinâmica como indicação para laparotomia, presença de lesão de víscera maciça, múltiplas lesões intra-abdominais, necessidade de cirurgia de controle de danos, lesões graves associadas e índice de trauma baixo.

Endovascular and open repair for blunt aortic injury, treated in one clinical institution in Brazil: a case series

OBJECTIVE: The objective of this retrospective study is to analyze and compare the results of conventional surgical repair and endovascular treatment of blunt aortic injury over the past 8 years. METHODS: Twenty-eight patients (25 male; mean age, 35 years) were treated for blunt aortic injury between April 2001 and March 2009 in a university hospital in Brazil. Twenty-six patients were included in the study: five were treated with operative repair (OR) and 21 with endovascular treatment (TEVAR). Two patients were excluded from analysis: one was managed conservatively, and one was treated with endovascular treatment for chronic dissection related to aortic trauma. RESULTS: Mean age was lower in the OR group than in the endovascular treatment group (17.8 vs. 38 years, P = .003). There was one death in the OR group and four deaths in the endovascular treatment group. Mean follow-up for the overall group was 33.6 months, with 48.7 months (range 8-83 months) for the OR group, and 29.8 months (range 2-91 months) for the TEVAR group. Mean time elapsed from injury to repair was 23.4 hours (range 8-48 h, median 20 h) for the OR group and 30.3 hours (range 2-240 h, median 18 h) for the TEVAR group (P = .374). The duration of surgery was shorter in the endovascular treatment group (142 versus 237 minutes; P = .005). There were no significant differences with respect to the number of postoperative days requiring mechanical ventilation, duration of ICU stay or duration of hospital stay. CONCLUSION: In this retrospective analysis, endovascular treatment was a safe method for repair of blunt aortic trauma, with immediate and midterm results that were comparable to those results obtained with operative repair. No complications from the stent graft were identified during follow-up. Nevertheless, long-term follow-up is necessary to confirm the effectiveness of this treatment.