From the Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
J Trauma Acute Care Surg. 2019 Dec;87(6):1308-1314. doi: 10.1097/TA.0000000000002462.
Bladder injuries often occur in the setting of polytrauma, and if severe, may require open surgical repairs. We assess the role of urologists and general surgeons (GS) in the open surgical management of bladder injuries and their outcomes in a traumatic setting.
Patients who underwent open bladder injury repair secondary to trauma from 2000 to 2017 by urology or GS were identified in the Pennsylvania Trauma Outcome Study database by International Classification of Diseases-9th Rev.-Clinical Modification procedure codes (57.19-57.93). Patient demographics, initial trauma assessment, length of hospital stay, associated complications, and mortality were evaluated. Urology management of a bladder injury was defined by documentation of a urologist in the operating room or urological consultation during the hospital stay. GS management was defined by documented bladder repair without urology involvement as described previously.
Of 624,504 patients in the database, 701 met inclusion criteria (419 managed by urology, 282 by GS). The most commonly performed procedure was suturing of bladder lacerations (80.5%). On univariate analysis, GS was more likely to manage patients with penetrating injuries and those who required exploratory laparotomy less than 2 hours upon arrival. Urology was more likely to manage patients with concomitant pelvic fractures and higher Injury Severity Score (ISS). On multivariate analysis, higher ISS was predictive of urology management (odds ratio, 1.83; 95% confidence interval, 1.17-2.87, p = 0.008), while patients who required urgent exploratory laparotomy was predictive of GS management (odds ratio, 0.34; 95% confidence interval, 0.21-0.55, p < 0.001). Patients with concomitant pelvic fractures (n = 318) were also more likely to have higher ISS (p < 0.001) and were more likely to be managed by urology (odds ratio, 1.52; 95% confidence interval, 1.01-2.30, p = 0.046). Mortality, length of hospital stay, and complication rates were not significantly different between the two specialties and among individual procedures.
Our study describes the landscape of traumatic bladder repairs between urology and GS. GS may maintain similar patient outcomes when managing select cases of traumatic bladder injuries in the absence of urologists.
Therapeutic, level IV.
膀胱损伤常发生于多发伤患者，若伤情严重，可能需要开放手术修复。我们评估泌尿科医生和普通外科医生（GS）在创伤环境下开放手术治疗膀胱损伤及其结果中的作用。
通过国际疾病分类第 9 版修订临床修正（ICD-9-CM）程序代码（57.19-57.93），在宾夕法尼亚创伤结局研究数据库中确定了 2000 年至 2017 年期间因创伤接受开放膀胱损伤修复的泌尿科或 GS 治疗的患者。评估了患者的人口统计学特征、初始创伤评估、住院时间、相关并发症和死亡率。泌尿科治疗膀胱损伤的定义是在住院期间有泌尿科医生在手术室或泌尿科会诊记录。GS 管理膀胱损伤的定义是有记录的无泌尿科参与的膀胱修复，如前所述。
在数据库的 624504 名患者中，有 701 名符合纳入标准（419 名由泌尿科管理，282 名由 GS 管理）。最常进行的手术是缝合膀胱裂伤（80.5%）。在单因素分析中，GS 更有可能管理穿透性损伤患者和那些在到达后 2 小时内需要剖腹探查的患者。泌尿科更有可能管理合并骨盆骨折和更高损伤严重程度评分（ISS）的患者。多因素分析显示，较高的 ISS 预测由泌尿科治疗（比值比，1.83；95%置信区间，1.17-2.87，p = 0.008），而需要紧急剖腹探查的患者预测由 GS 治疗（比值比，0.34；95%置信区间，0.21-0.55，p < 0.001）。合并骨盆骨折的患者（n = 318）也更有可能具有较高的 ISS（p < 0.001），并且更有可能由泌尿科治疗（比值比，1.52；95%置信区间，1.01-2.30，p = 0.046）。两个专业之间以及个别手术之间的死亡率、住院时间和并发症发生率没有显著差异。
我们的研究描述了泌尿科和 GS 之间创伤性膀胱修复的情况。在没有泌尿科医生的情况下，GS 可能对治疗某些创伤性膀胱损伤保持相似的患者结局。
治疗性，IV 级。
