Impact of Genitourinary Injuries on Patients Requiring an Emergency Laparotomy for Trauma.
W Britt Zimmerman, Alfred E Baylor, Lisa Hall Zimmerman, Heather Dolman, Jeremy R Ciullo, Jessica Dornbush, Andrew R Isaacson, Roozbeh Mansour, Robert F Wilson, James G Tyburski
Author Information
W Britt Zimmerman: Urology, Michigan State University, East Lansing, USA.
Alfred E Baylor: The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA.
Lisa Hall Zimmerman: Department of Pharmaceutical Services, Beaumont Health, Royal Oak, USA.
Heather Dolman: The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA.
Jeremy R Ciullo: The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA.
Jessica Dornbush: The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA.
Andrew R Isaacson: The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA.
Roozbeh Mansour: The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA.
Robert F Wilson: The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA.
James G Tyburski: The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA.
Introduction In patients having emergency abdominal surgery for trauma, the presence of urologic injury tends to increase mortality and morbidity. Methods This retrospective study evaluated patients requiring emergency surgery for abdominal trauma at a Level 1 Trauma Center over 30 years (1980-2010). Special attention was given to patients with concomitant genitourinary (GU) injuries. Results Of 1105 patients requiring an emergency laparotomy for trauma, 242 (22%) had urologic injuries including kidney 178 (16%), ureter 47 (4%), and bladder 46 (4%). Of the 242 patients, 50 (20%) died early (<48 hours) and 13 (5%) died later, primarily due to infection. A concept of "seven deadly signs" of hypoperfusion was developed. In patients with GU injuries, the presence of any deadly sign of hypoperfusion increased the mortality rate from 4% (6/152) to 63% (56/90), p<0.001. Of the 53 patients having a nephrectomy, 36 (68%) had one or more deadly signs and 27 (75%) died. Of 17 without deadly signs, only 2 (12%) died (p=0.001). Of 167 GU patients receiving blood, 59 (35%) developed infection vs 3/75(4%) in those receiving no blood (p<0.001). Conclusions The presence of deadly signs of severe injury and hypoperfusion on admission was the major factor determining mortality. With a severely injured kidney plus any deadly signs of hypoperfusion, special efforts should be made to avoid a nephrectomy.
