Lenart Emily K, Lewis Richard H, Sharpe John P, Fischer Peter E, Croce Martin A, Magnotti Louis J
Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
Surg Open Sci. 2020 Jun 5;2(4):1-4. doi: 10.1016/j.sopen.2020.05.001. eCollection 2020 Oct.
Patients who present at night following penetrating abdominal trauma are thought to have more severe injuries and increased risk for morbidity and mortality. The current literature is at odds regarding this belief. The purpose of this study was to evaluate time of day on outcomes following laparotomy for penetrating abdominal trauma.
Patients undergoing laparotomy following penetrating abdominal trauma over a 12-month period at a level I trauma center were stratified by age, sex, severity of shock, injury, operative complexity, and time of day (DAY = 0700-1900, NIGHT = 1901-0659). Outcomes of damage control laparotomy, ventilator days, intensive care unit length of stay, hospital length of stay, morbidity, and mortality were compared between DAY and NIGHT.
A total of 210 patients were identified: 145 (69%) comprised NIGHT, and 65 (31%) comprised DAY. Overall mortality was 2.9%. Both injury severity and intraoperative transfusions were increased with NIGHT with no difference in morbidity (37% vs 40%, P = 0.63) or mortality (2.1% vs 4.6%, P = 0.31). Adjusting for sex, time of day, injury severity, and operative complexity, only abdominal abbreviated injury severity (odds ratio 1.46; 95% confidence interval 1.07-1.99, P = .019) and operative transfusions (odds ratio 1.18; 95% confidence interval 1.09-1.28, P < .0001) were identified as independent predictors of damage control laparotomy using multivariable logistic regression (area under the curve 0.96).
The majority of operative penetrating abdominal trauma occurs at night with increased injury burden, more operative transfusions, and increased use of damage control laparotomy with no difference in morbidity and mortality. Outcomes at a fully staffed and operational trauma center should not be impacted by time of day.
腹部穿透伤患者在夜间就诊被认为损伤更严重，发病和死亡风险增加。目前的文献对此观点存在分歧。本研究的目的是评估腹部穿透伤剖腹手术后一天中的时间对预后的影响。
在一级创伤中心，对12个月内接受腹部穿透伤剖腹手术的患者，按年龄、性别、休克严重程度、损伤情况、手术复杂性和一天中的时间（白天=07:00-19:00，夜间=19:01-06:59）进行分层。比较白天和夜间损伤控制剖腹手术的结果、呼吸机使用天数、重症监护病房住院时间、住院总时间、发病率和死亡率。
共纳入210例患者：145例（69%）为夜间组，65例（31%）为白天组。总体死亡率为2.9%。夜间组的损伤严重程度和术中输血量均增加，发病率（37%对40%，P=0.63）和死亡率（2.1%对4.6%，P=0.31）无差异。在对性别、一天中的时间、损伤严重程度和手术复杂性进行校正后，使用多变量逻辑回归分析（曲线下面积0.96），仅腹部简明损伤严重程度（比值比1.46；95%置信区间1.07-1.99，P=0.019）和手术输血量（比值比1.18；95%置信区间1.09-1.28，P<0.0001）被确定为损伤控制剖腹手术的独立预测因素。
大多数腹部穿透伤手术发生在夜间，损伤负担增加，手术输血量更多，损伤控制剖腹手术的使用增加，但发病率和死亡率无差异。人员配备齐全且运转正常的创伤中心的预后不应受一天中时间的影响。
