Analysis of trauma patients with unplanned returns to the operating room
Areg Grigorian, Sebastian Schubl, Viktor Gabriel, Austin Dosch, Victor Joe, Nicole Bernal, Taimoore Dogar, Jeffry Nahmias
University of California, Irvine, Surgery, Orange, USA
Abstract
Objective: Trauma patients undergoing damage-control surgery may have a planned return to the operating room. In contrast, little is known about unplanned returns to the operating room (uROR) in trauma. The aim of this study was to identify risk factors for uROR in trauma patients. It is hypothesized that blunt trauma patients with uROR have higher mortality when compared to penetrating trauma patients with uROR. Additionally, it is hypothesized that trauma patients with uROR after thoracotomy have higher mortality than patients with uROR after laparotomy.
Material and Methods: A retrospective analysis of the National Trauma Data Bank from 2011-2015 including any adult patient with an uROR was performed.
Results: From 3.447.320 patients, 9.269 (0.2%) were identified to have uROR. In a multivariable logistic regression analysis, 27 independent predictors were identified for risk of uROR with the strongest independent risk factor being compartment syndrome (OR= 10.50, CI= 9.35-11.78, p< 0.001). Blunt (compared to penetrating) mechanism was associated with higher risk for mortality in patents with uROR (OR= 1.69, CI= 1.14-2.51, p< 0.001) as was re-incision thoracotomy (RT) compared to re-incision laparotomy (RL) (OR= 2.22, CI= 1.29-3.84, p< 0.001).
Conclusion: The strongest risk factor for uROR in trauma is compartment syndrome. Both a blunt (compared to penetrating) mechanism and RT (compared to RL) are independent risk factors for mortality in patients undergoing an uROR.
Keywords: Unplanned return to the operating room, return to the operating room, re-incision thoracotomy, re-incision laparotomy, trauma
Cite this article as: Grigorian A, Schubl S, Gabriel V, Dosch A, Joe V, Bernal N, et al. Analysis of trauma patients with unplanned returns to the operating room. Turk J Surg 2019; 35 (1): 54-61
This study was approved by the Institutional Review Board at the University of California, Irvine.
This research involved humans. However, since this retrospective study was performed using a national database with deidentified patients, risk to participants is minimal. There is no consent required.
Externally peer-reviewed.
Consept - A.G., S.S., J.N.; Design - A.G., S.S., J.N.; Supervision - J.N.; Data Collection and/or Processing - A.G., T.D.; Analysis and Interpretation - A.G., S.S., V.G., A.D., V.J., T.D., N.B., J.N.; Literature Search - A.G., J.N.; Writing Manuscript - A.G.; Critical Reviews - A.G., S.S., V.G., A.D., V.J., N.B., T.D., J.N.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.