Outcome determinants after traumatic bowel injuries: F35

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Aim:Traumatic bowel injuries are rare but lead to important morbidity and mortality. There is discussion about the best management strategy.Method:A retrospective analysis of the clinical records of 102 consecutive patients after surgery for traumatic bowel injury between January 2000 and December 2009.Results:The mean age was 40 years. The average NISS score was 18.8. Most patients (79.4%) were male and 52% suffered blunt trauma. The mean time to surgery was 21 hours but in 62.7%, surgery was undertaken in the first 6 hours. Thirty one (30.4%) patients had post-operative complications, 12 of whom were intra-abdominal. In hospital mortality was 4.9%. Mortality was directly related with time to surgery (P < 0.001), blunt trauma (P = 0.03), ASA score (P = 0.001), multiple intestinal lesions (P < 0.001), extra-abdominal injuries (P = 0.002), the Mannheim Peritonitis Index (P = 0.02) and NISS score (P = 0.001). Besides these, morbidity was also related with tachycardia (P = 0.04), hypotension (P = 0.001) and haemoglobin < 10 g/dl (P = 0.001). In multivariate analysis, only NISS (P = 0.002), time-to-surgery (P = 0.007), ASA (P = 0.015) and injured organ (P = 0.024) were significantly related to morbidity.Conclusion:The multivariate analysis ofprognostic factors selects a group of determinants that represent the basic determinants of patient outcome: physiologic state (ASA), global injury (NISS), peritoneal soiling (colonic lesion) and time-to-surgery which is the only related to the quality-of-care.

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