Purpose:Trauma centres have been proven to provide better outcomes in developed countries for overall trauma,but there is limited literature on the systematic factors that describe any discrepancies in outcomes for tr...Purpose:Trauma centres have been proven to provide better outcomes in developed countries for overall trauma,but there is limited literature on the systematic factors that describe any discrepancies in outcomes for trauma laparotomies in these centres.This study was conducted to examine and interrogate the effect of systematic factors on patients undergoing a trauma laparotomy in a developed country,intending to identify potential discrepancies in the outcome.Methods:This was a retrospective study of all laparotomies performed for trauma at a level 1 trauma centre in New Zealand.All adult patients who had undergone an index laparotomy for trauma between February 2012 and November 2020 were identified and laparotomies for both blunt and penetrating trauma were included.Repeat laparotomies and trauma laparotomies in children were excluded.The primary clinical outcomes reviewed included morbidity,length of hospital stay,and mortality.All statistical analysis was performed using R v.4.0.3.Results:During the 9-year study period,204 trauma laparotomies were performed at Waikato hospital.The majority(83.3%)were performed during office hours(170/204),and the remaining 16.7%were performed after hours(34/204).And 61.3%were performed on a weekday(125/204),whilst 38.7%were performed on the weekend/public holiday(79/204).Most of the parameters in office hours and after hours groups had no statistically significant difference,except lactate(p=0.026).Most of the variables in weekday and weekend groups had no statistically significant difference,except pH,lactate,length of stay,and gastrointestinal complications(p=0.012,p<0.001,p=0.003,p=0.020,respectively).Conclusion:The current trauma system at Waikato hospital is capable of delivering care for trauma laparotomy patients with the same outcome regardless of working hours or after hours,weekday or weekend.This confirms the importance of a robust trauma system capable of responding to the sudden demands placed on it.展开更多
目的:通过与传统开腹手术的临床疗效对比,评估腹腔镜技术应用于腹部创伤的临床价值。方法:回顾性分析我院急救创伤中心近9年收治的腹部创伤患者病例资料。用1∶1倾向得分匹配方法为腔镜病例选择最合适的开腹对照病例。将匹配后的病例作...目的:通过与传统开腹手术的临床疗效对比,评估腹腔镜技术应用于腹部创伤的临床价值。方法:回顾性分析我院急救创伤中心近9年收治的腹部创伤患者病例资料。用1∶1倾向得分匹配方法为腔镜病例选择最合适的开腹对照病例。将匹配后的病例作为研究对象,根据其手术方式分别纳入开腹组和腔镜组,分析对比两组间入院时心率和血压、受伤后院前时间、院内术前时间、手术时间、术中出血量、术后ICU时间、术后呼吸机时间、术后首次肛门排气时间、术后引流时间、总住院天数、总住院费用、并发症发生率、非计划性二次手术率等临床指标的差异。结果:共纳入222例患者作为研究对象,其中开腹组和腔镜组各111例(各占50%);最常见的致伤因素为交通事故伤,共75例(34%);最常见的受累脏器为小肠,共55例(25%)。腔镜组总住院时间明显短于开腹组(14 d vs.18 d,P=0.000);术中出血量较开腹组明显减少(200 mL vs.400 mL,P=0.000);术后首次肛门排气时间短于开腹组[(3.54±2.52)d vs.(4.63±2.98)d,P=0.004]。但平均手术时间长于开腹组[(3.51±1.56)h vs.(3.08±1.46)h,P=0.030];总住院费用亦高于开腹组(74128.00元vs.47911.40元,P=0.004)。结论:腹腔镜是一种有效的诊断工具,同时也是一种安全的微创治疗手段。其应用于腹部创伤的治疗能减少术中出血,避免不必要的开腹探查,有效缩短住院时间,从而降低腹部创伤患者术后并发症发生率和病死率。展开更多
文摘Purpose:Trauma centres have been proven to provide better outcomes in developed countries for overall trauma,but there is limited literature on the systematic factors that describe any discrepancies in outcomes for trauma laparotomies in these centres.This study was conducted to examine and interrogate the effect of systematic factors on patients undergoing a trauma laparotomy in a developed country,intending to identify potential discrepancies in the outcome.Methods:This was a retrospective study of all laparotomies performed for trauma at a level 1 trauma centre in New Zealand.All adult patients who had undergone an index laparotomy for trauma between February 2012 and November 2020 were identified and laparotomies for both blunt and penetrating trauma were included.Repeat laparotomies and trauma laparotomies in children were excluded.The primary clinical outcomes reviewed included morbidity,length of hospital stay,and mortality.All statistical analysis was performed using R v.4.0.3.Results:During the 9-year study period,204 trauma laparotomies were performed at Waikato hospital.The majority(83.3%)were performed during office hours(170/204),and the remaining 16.7%were performed after hours(34/204).And 61.3%were performed on a weekday(125/204),whilst 38.7%were performed on the weekend/public holiday(79/204).Most of the parameters in office hours and after hours groups had no statistically significant difference,except lactate(p=0.026).Most of the variables in weekday and weekend groups had no statistically significant difference,except pH,lactate,length of stay,and gastrointestinal complications(p=0.012,p<0.001,p=0.003,p=0.020,respectively).Conclusion:The current trauma system at Waikato hospital is capable of delivering care for trauma laparotomy patients with the same outcome regardless of working hours or after hours,weekday or weekend.This confirms the importance of a robust trauma system capable of responding to the sudden demands placed on it.
文摘目的:通过与传统开腹手术的临床疗效对比,评估腹腔镜技术应用于腹部创伤的临床价值。方法:回顾性分析我院急救创伤中心近9年收治的腹部创伤患者病例资料。用1∶1倾向得分匹配方法为腔镜病例选择最合适的开腹对照病例。将匹配后的病例作为研究对象,根据其手术方式分别纳入开腹组和腔镜组,分析对比两组间入院时心率和血压、受伤后院前时间、院内术前时间、手术时间、术中出血量、术后ICU时间、术后呼吸机时间、术后首次肛门排气时间、术后引流时间、总住院天数、总住院费用、并发症发生率、非计划性二次手术率等临床指标的差异。结果:共纳入222例患者作为研究对象,其中开腹组和腔镜组各111例(各占50%);最常见的致伤因素为交通事故伤,共75例(34%);最常见的受累脏器为小肠,共55例(25%)。腔镜组总住院时间明显短于开腹组(14 d vs.18 d,P=0.000);术中出血量较开腹组明显减少(200 mL vs.400 mL,P=0.000);术后首次肛门排气时间短于开腹组[(3.54±2.52)d vs.(4.63±2.98)d,P=0.004]。但平均手术时间长于开腹组[(3.51±1.56)h vs.(3.08±1.46)h,P=0.030];总住院费用亦高于开腹组(74128.00元vs.47911.40元,P=0.004)。结论:腹腔镜是一种有效的诊断工具,同时也是一种安全的微创治疗手段。其应用于腹部创伤的治疗能减少术中出血,避免不必要的开腹探查,有效缩短住院时间,从而降低腹部创伤患者术后并发症发生率和病死率。
