Kayla M Wilson, Marissa W Mery, Erika Bengtson, Sarah E McWilliam, James M Bradford, Pedro G R Teixeira, Joseph J Dubose, Tatiana C Cardenas, Sadia Ali, Carlos V R Brown
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The objective of this study was to identify intraoperative factors associated with uROR after emergent hemorrhage control procedures in bleeding trauma patients.</p><p><strong>Methods: </strong>We used anesthetic record of intraoperative management to perform a retrospective study (2017-2022) of bleeding trauma patients who were taken for an emergent hemorrhage control operation.</p><p><strong>Results: </strong>A total of 225 patients met the inclusion criteria, 46 (20%) had uROR, and 181 (80%) did not. While there was no difference in demographics, mechanism, admission physiology, or time from emergency department to operating room, the uROR patients had a higher Injury Severity Score (30 vs. 25, p = 0.007). While there was no difference in volume of crystalloid infused (3,552 ± 2,279 mL vs. 2,977 ± 2,817 mL, p = 0.20), whole blood (2.2 ± 0.9 vs. 2.0 ± 0.5, p = 0.20), or platelets (11.6 ± 8.6 vs. 9.2 ± 9.0, p = 0.14), the uROR group received more packed red blood cells (11.5 ± 10.6 vs. 7.8 ± 7.5, p = 0.006) and plasma (9.6 ± 8.3 vs. 6.5 ± 6.6, p = 0.01), and more uROR patients received ≥10 U of packed red blood cells (48% vs. 27%, p = 0.006). Damage-control surgery (DCS) was more common in uROR patients (78% vs. 45%, p < 0.0001). After logistic regression, ≥10 U of packed cells in the operating room (4.3 [1.5-12.8], p = 0.009), crystalloid (1.0 [1.0-1.001], p = 0.009), International Normalized Ratio (INR) (7.6 [1.3-45.7], p = 0.03), and DCS (5.7 [1.7-19.1], p = 0.005) were independently associated with uROR.</p><p><strong>Conclusion: </strong>Massive transfusion, crystalloid resuscitation, persistent coagulopathy, and DCS are the most significant risk factors for uROR. During hemorrhage control surgery in bleeding trauma patients who receive ≥10 U of blood, providers must maintain a keen focus on minimizing crystalloid and ongoing balanced resuscitation, particularly during damage-control procedures.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"64-68"},"PeriodicalIF":2.9000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intraoperative factors associated with unplanned return to the operating room after emergent hemorrhage control surgery.\",\"authors\":\"Kayla M Wilson, Marissa W Mery, Erika Bengtson, Sarah E McWilliam, James M Bradford, Pedro G R Teixeira, Joseph J Dubose, Tatiana C Cardenas, Sadia Ali, Carlos V R Brown\",\"doi\":\"10.1097/TA.0000000000004396\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Unplanned return to the operating room (uROR) is associated with worse outcomes and increased mortality. Little is known regarding intraoperative factors associated with uROR after emergent surgery in trauma patients. The objective of this study was to identify intraoperative factors associated with uROR after emergent hemorrhage control procedures in bleeding trauma patients.</p><p><strong>Methods: </strong>We used anesthetic record of intraoperative management to perform a retrospective study (2017-2022) of bleeding trauma patients who were taken for an emergent hemorrhage control operation.</p><p><strong>Results: </strong>A total of 225 patients met the inclusion criteria, 46 (20%) had uROR, and 181 (80%) did not. While there was no difference in demographics, mechanism, admission physiology, or time from emergency department to operating room, the uROR patients had a higher Injury Severity Score (30 vs. 25, p = 0.007). While there was no difference in volume of crystalloid infused (3,552 ± 2,279 mL vs. 2,977 ± 2,817 mL, p = 0.20), whole blood (2.2 ± 0.9 vs. 2.0 ± 0.5, p = 0.20), or platelets (11.6 ± 8.6 vs. 9.2 ± 9.0, p = 0.14), the uROR group received more packed red blood cells (11.5 ± 10.6 vs. 7.8 ± 7.5, p = 0.006) and plasma (9.6 ± 8.3 vs. 6.5 ± 6.6, p = 0.01), and more uROR patients received ≥10 U of packed red blood cells (48% vs. 27%, p = 0.006). Damage-control surgery (DCS) was more common in uROR patients (78% vs. 45%, p < 0.0001). After logistic regression, ≥10 U of packed cells in the operating room (4.3 [1.5-12.8], p = 0.009), crystalloid (1.0 [1.0-1.001], p = 0.009), International Normalized Ratio (INR) (7.6 [1.3-45.7], p = 0.03), and DCS (5.7 [1.7-19.1], p = 0.005) were independently associated with uROR.</p><p><strong>Conclusion: </strong>Massive transfusion, crystalloid resuscitation, persistent coagulopathy, and DCS are the most significant risk factors for uROR. 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引用次数: 0
摘要
背景：非计划返回手术室（uROR）与更差的预后和更高的死亡率有关。人们对创伤患者紧急手术后与意外返回手术室相关的术中因素知之甚少。本研究的目的是确定出血创伤患者紧急止血手术后与意外返回手术室相关的术中因素：我们利用麻醉记录术中管理，对接受紧急止血手术的出血性创伤患者进行回顾性研究（2017-2022年）：共有225例患者符合纳入标准，46例（20%）有uROR，181例（80%）无uROR。虽然在人口统计学、机制、入院生理学或从急诊科到手术室的时间上没有差异，但uROR 患者的损伤严重程度评分更高（30 对 25，P = 0.007）。虽然晶体液输注量（3,552 ± 2,279 mL vs. 2,977 ± 2,817 mL，p = 0.20）、全血输注量（2.2 ± 0.9 vs. 2.0 ± 0.5，p = 0.20）或血小板输注量（11.6 ± 8.6 vs. 9.2 ± 9.0，p = 0.14），uROR 组接受了更多的包装红细胞（11.5 ± 10.6 vs. 7.8 ± 7.5，p = 0.006）和血浆（9.6 ± 8.3 vs. 6.5 ± 6.6，p = 0.01），更多的 uROR 患者接受了≥10 U 的包装红细胞（48% vs. 27%，p = 0.006）。损伤控制手术（DCS）在uROR患者中更为常见（78% 对 45%，P < 0.0001）。经过逻辑回归，手术室中≥10 U的包装细胞（4.3 [1.5-12.8]，p = 0.009）、晶体液（1.0 [1.0-1.001]，p = 0.009）、国际标准化比率（INR）（7.6 [1.3-45.7]，p = 0.03）和DCS（5.7 [1.7-19.1]，p = 0.005）与uROR独立相关：结论：大量输血、晶体液复苏、持续凝血病和 DCS 是导致 uROR 的最重要风险因素。在对输血量≥10 U 的大出血创伤患者进行出血控制手术期间，医疗人员必须密切关注尽量减少晶体液和持续平衡复苏，尤其是在损伤控制手术期间：证据级别：回顾性/描述性；IV 级。
Intraoperative factors associated with unplanned return to the operating room after emergent hemorrhage control surgery.
Background: Unplanned return to the operating room (uROR) is associated with worse outcomes and increased mortality. Little is known regarding intraoperative factors associated with uROR after emergent surgery in trauma patients. The objective of this study was to identify intraoperative factors associated with uROR after emergent hemorrhage control procedures in bleeding trauma patients.
Methods: We used anesthetic record of intraoperative management to perform a retrospective study (2017-2022) of bleeding trauma patients who were taken for an emergent hemorrhage control operation.
Results: A total of 225 patients met the inclusion criteria, 46 (20%) had uROR, and 181 (80%) did not. While there was no difference in demographics, mechanism, admission physiology, or time from emergency department to operating room, the uROR patients had a higher Injury Severity Score (30 vs. 25, p = 0.007). While there was no difference in volume of crystalloid infused (3,552 ± 2,279 mL vs. 2,977 ± 2,817 mL, p = 0.20), whole blood (2.2 ± 0.9 vs. 2.0 ± 0.5, p = 0.20), or platelets (11.6 ± 8.6 vs. 9.2 ± 9.0, p = 0.14), the uROR group received more packed red blood cells (11.5 ± 10.6 vs. 7.8 ± 7.5, p = 0.006) and plasma (9.6 ± 8.3 vs. 6.5 ± 6.6, p = 0.01), and more uROR patients received ≥10 U of packed red blood cells (48% vs. 27%, p = 0.006). Damage-control surgery (DCS) was more common in uROR patients (78% vs. 45%, p < 0.0001). After logistic regression, ≥10 U of packed cells in the operating room (4.3 [1.5-12.8], p = 0.009), crystalloid (1.0 [1.0-1.001], p = 0.009), International Normalized Ratio (INR) (7.6 [1.3-45.7], p = 0.03), and DCS (5.7 [1.7-19.1], p = 0.005) were independently associated with uROR.
Conclusion: Massive transfusion, crystalloid resuscitation, persistent coagulopathy, and DCS are the most significant risk factors for uROR. During hemorrhage control surgery in bleeding trauma patients who receive ≥10 U of blood, providers must maintain a keen focus on minimizing crystalloid and ongoing balanced resuscitation, particularly during damage-control procedures.
Level of evidence: Therapeutic/Care Management; Level IV.
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The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
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