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OBJECTIVE: the aim of this study was to identify associated factors with the increased length of hospital stay for patients undergoing surgical treatment for liver trauma, and predictors of mortality as well as the epidemiology of this trauma. METHODS: retrospective study of 191 patients admitted to the Cajuru University Hospital, a reference in the treatment of multiple trauma patients, between 2010 and 2017, with epidemiological, clinicopathological and therapeutic variables analyzed using the STATA version 15.0 program. RESULTS: most of the included patients were men with a mean age of 29 years. Firearm injury represents the most common trauma mechanism. The right hepatic lobe was injured in 51.2% of the cases, and hepatorraphy was the most commonly used surgical correction. The length of hospital stay was an average of 11 (0-78) days and the length of stay in the intensive care unit was 5 (0-52) days. Predictors for longer hospital stay were the mechanisms of trauma, hemodynamic instability at admission, number of associated injuries, degree of liver damage and affected lobe, used surgical technique, presence of complications, need for reoperation and other surgical procedures. Mortality rate was 22.7%. CONCLUSIONS: the study corroborated the epidemiology reported by the literature. Greater severity of liver trauma and associated injuries characterize patients undergoing surgical treatment, who have increased hospital stay due to the penetrating trauma, hemodynamic instability, hepatic packaging, complications and reoperations.
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Armas de Fogo , Ferimentos por Arma de Fogo , Adulto , Hospitalização , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Fígado/lesões , Fígado/cirurgia , Masculino , Estudos Retrospectivos , Centros de TraumatologiaRESUMO
INTRODUÇÃO: A cirurgia de resgate á baseada em alguns pilares básicos: trauma, cirurgia de emergência, cuidados intensivos cirúrgicos, cuidados nutricionais, cirurgia geral eletiva, resgate cirúrgico e retirar a sepse do abdome. Este modelo de tratamento cirúrgico demonstrou maior eficiência, menor tempo de operação e menor tempo de internação hospitalar. Este artigo aborda dois casos clínicos em que o modelo de cirurgia de resgate foi usado como base para o tratamento. OBJETIVO: A ênfase deste caso é demonstrar que há uma necessidade de uma equipe de cirurgiões prontos para atuar com base nos cinco pilares da cirurgia de resgate para manejar pacientes gravemente feridos. METODOLOGIA: Esse estudo se caracteriza por ser um relato de casos, com análise de prontuário de maneira retrospectiva. CONCLUSÃO: É importante reconhecer que, embora não haja consenso entre as diretrizes para o tratamento de algumas morbidades agudas, cada paciente deve ser tratado individualmente para reduzir a mortalidade intra-hospitalar
INTRODUCTION: Rescue surgery is based on some basic pillars: trauma, emergency surgery, surgical intensive care, elective general surgery and surgical rescue. This model of surgical treatment demonstrated greater efficiency, shorter operating time and shorter hospital stay. This article approach two clinical cases in which the rescue surgery model was used as the basis for treatment. OBJECTIVE: The emphasis of this case is to demonstrate that there is a need for a team of surgeons ready to act based on the five pillars of rescue surgery to manage severely injured patients. METHODOLOGY: This study is characterized by being a case report, with retrospective analysis of medical records. CONCLUSION: It is important to recognize that, although there is no consensus between the guidelines for the treatment of some acute morbidities, each patient must be treated individually to reduce in-hospital mortality
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Objective: To analyze the characteristics of trauma patients with renal lesions treated at a university hospital in Curitiba. Methods: We conducted a retrospective, cross-sectional study guided by review of medical records of trauma victims who underwent surgical treatment. The variables analyzed were age, gender, mechanism of injury, degree of kidney damage, conduct individualized according to the degree of renal injury, associated injuries, complications and deaths. We classified lesions according to the American Association of Trauma Surgery (TSAA). Results: We analyzed 794 records and found renal lesions in 33 patients, with mean age 29.8 years, most (87.8%) being male. Penetrating trauma accounted for 84.8% of cases. The most common renal injuries were grade II (33.3%), followed by grade I (18.1%), III, IV and V. Nephrectomy treated 45.4% of injuries, 73.3% being total nephrectomy, and 45.4% by nephrorraphy. In 9% treatment was non-surgical. Only 12.1% of patients had isolated renal lesions. Complications ensued in 15.1% and mortality was 6.06%. Conclusion: The surgical approach was preferred due to penetrating trauma mechanism. We achieved low rates of complications and deaths, and neither case could be directly related to kidney damage, and there were patients with multiple lesions. In this sample, we could not observe a direct relationship between kidney damage and complications, deaths or the type of conduct employed.
Objetivo: analisar as características de pacientes vítimas de trauma, com lesões renais atendidos em um hospital universitário de Curitiba. Métodos: estudo transversal retrospectivo guiado por revisão de prontuários de vítimas de trauma submetidos ao tratamento cirúrgico. As variáveis analisadas foram idade, sexo, mecanismo de trauma, grau das lesões renais, conduta individualizada de acordo com o grau da lesão renal, lesões associadas, complicações e óbitos. As lesões foram classificadas de acordo com a Associação Americana de Cirurgia do Trauma (AAST). Resultados: foram analisados 794 prontuários, a lesão renal foi encontrada em 33 pacientes, a média de idade foi 29,8 anos, a maioria dos pacientes era (87,8%) do sexo masculino. O trauma penetrante foi responsável por 84,8% dos casos. As lesões mais frequentes foram as de grau II (33,3%), seguidas pelas lesões de grau I (18,1%) e pelas lesões de grau III, IV e V. Foram tratadas com nefrectomia, 45,4% das lesões, 73,3% por nefrectomia total e 45,4%, por nefrorrafia. Em 9% o tratamento não foi cirúrgico. Apenas 12,1% dos pacientes apresentaram lesões renais isoladas. Complicações foram observadas em 15,1% e a taxa de óbito foi 6,06%. Conclusão: a abordagem cirúrgica foi a preferencial devido ao mecanismo de trauma penetrante. Obtivemos baixos índices de óbitos e complicações, sendo que nenhum dos casos pôde ser relacionado diretamente à lesão renal, e ocorreram em pacientes com múltiplas lesões. Nesta amostra, não foi possível provar relação direta entre lesão renal e complicações, óbitos ou com o tipo de conduta empregada.
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Humanos , Masculino , Feminino , Adulto , Traumatismo Múltiplo/epidemiologia , Hospitais Universitários , Rim/lesões , Ferimentos não Penetrantes , Traumatismo Múltiplo/cirurgia , Estudos Transversais , Estudos Retrospectivos , Rim/cirurgiaRESUMO
OBJECTIVE: To analyze the characteristics of trauma patients with renal lesions treated at a university hospital in Curitiba. METHODS: We conducted a retrospective, cross-sectional study guided by review of medical records of trauma victims who underwent surgical treatment. The variables analyzed were age, gender, mechanism of injury, degree of kidney damage, conduct individualized according to the degree of renal injury, associated injuries, complications and deaths. We classified lesions according to the American Association of Trauma Surgery (TSAA). RESULTS: We analyzed 794 records and found renal lesions in 33 patients, with mean age 29.8 years, most (87.8%) being male. Penetrating trauma accounted for 84.8% of cases. The most common renal injuries were grade II (33.3%), followed by grade I (18.1%), III, IV and V. Nephrectomy treated 45.4% of injuries, 73.3% being total nephrectomy, and 45.4% by nephrorraphy. In 9% treatment was non-surgical. Only 12.1% of patients had isolated renal lesions. Complications ensued in 15.1% and mortality was 6.06%. CONCLUSION: The surgical approach was preferred due to penetrating trauma mechanism. We achieved low rates of complications and deaths, and neither case could be directly related to kidney damage, and there were patients with multiple lesions. In this sample, we could not observe a direct relationship between kidney damage and complications, deaths or the type of conduct employed.