Selim TURHANOĞLU, Menekşe OKŞAR, Çağla B. AKKURT

SAVAŞ SIRASINDA SİVİL ATEŞLİ SİLAH YARALANMALARINI TAKİBEN ORTAYA ÇIKAN MORTALİTE: RETROSPEKTIF KOHORT ARAŞTIRMA

Amaç Bu çalışma savaş yaralanması nedeni ile ameliyat edi- len hastalar arasında, cerrahi grupların sınıflandırma- sını yaralanma şiddetinin yerine kullanarak, mortaliteyi etkileyen faktörleri tanımlamayı amaçlamaktadır. Gereç ve Yöntem Bu Türkiye’de bir üçüncü basamak üniversite hasta- nesinde 2011 ve 2014 yılları arasında ameliyata alı- nan hastalarda yapılan retrospektif bir çalışmadır. Tüm hastalar ateşli silah yaralanması nedeni ile ameliyata alınmış ve ASA skorları I–II idi. Yaralanmanın şiddeti- ni ve hastanın son durumunu (sağ kalım veya ölüm) saptamak için cerrahinin tipi ve bununla ilişkili anestezi işlemine dayalı bir derecelendirme sistemi-Türkiye’de Sağlık Uygulamaları Tebliğinde tanımlandığı şekli ile- kullanıldı. Bulgular Şifa ile taburcu olanların hastane süreleri ölenlerden anlamlı dercede daha uzundu [medyan (min-maks.) olarak sırası ile 12 (0-559).ve 7.5(0-468) gün]. Has- talar altı kategorik cerrahi gruba (A2, A3, B, C, D, ve E) dağılmıştı. Tüm mortalite %11.3 idi ancak A2, C, ve D gruplarında hastaların sırası ile %8.1, %40.3 ve %40.3’ü, ve şifa-sağ kalım yine A2, C, D grup hasta- larda sırası ile %2.4, %54.1, %25.8 oranında idi. Has- tanın son durumunu etkileyen bağımsız değişkenlerin cinsiyet, yaş ve cerrahi gruplardan A2, C ve D için kat- sayıları anlamlı idi. Sonuç Cerrahi operasyon kategorileri ve sivil ateşli silah ya- ralanmaları arasında bir ilişki olduğu gözükmektedir, Dahası, modelimizdeki cerrahi grupları ile ilişkili katsa- yılar benzer populasyonlarda mortalite riskini tahmin etmeye yardımcı olabilir.

POSTOPERATIVE MORTALITY FOLLOWING CIVILIAN FIREARMS INJURY DURING WAR: A RETROSPECTIVE COHORT STUDY

Objective This study aims to identify factors affecting mortality following surgery for civilian firearms injuries using surgical classification as a surrogate marker of injury severity. Material and Methods This was a retrospective study of patients who un- derwent surgery at a tertiary university hospital in Turkey between 2011 and 2014. All patients had susta- ined firearms injury and had an American Society of Anesthesiologists score of I-II. A grading system defi- ned by the Communiqué on Health Practices in Turkey was used based on the surgery type and anesthetic procedure to determine the severity of injury and its relation with patient outcome (survival or death). Results The median duration of hospital stay of patients who were discharged post healing was significantly longer than those who died [12 (0–559).vs 7.5 (0–468) days, respectively]. Overall mortality was 11.3%; however, the mortality of patients was 8.1%, 40.3%, and 40.3% in groups A2, C, and D, respectively. Healing in groups A2, C, and D was 2.4%, 54.1% and 25.8%, respec- tively. Independent variables affecting the coefficient of patient discharge status for sex, age, and surgical groups A2, C, and D were found to be significant. Conclusion There was an association between the surgical groups and the firearms injuries sustained by civilians. More- over, the coefficients associated with surgical group in our model may help predict the mortality risk in similar populations.

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