Risk factors for death in trauma patients after surgery under general anesthesia_West China Medical Journal

Authors：

ZHANG Fei , ZHANG Yonghong , DU Juan , HUANG Xuemei , HE Ling , WANG Xiaolin , XU Suihan ,  LI Jun

Department of Anesthesiology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan 621000, P. R. China;

Corresponding author：

LI Jun, Email: lj89199@163.com

Keywords：

Trauma; General anesthesia; Postoperative mortality; Risk factors

DOI：

10.7507/1002-0179.202105164

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the risk factors for death within 7 days after admission in trauma patients undergoing surgery under general anesthesia, and provide evidence for predicting the outcomes of those patients and guidance for clinical practices.Methods The basic information and perioperative data of trauma patients who underwent surgery under general anesthesia between January 1st 2019 and December 31st 2020 were collected from the Hospital Information System and the Anesthesia Information Management System. Patients who died within 7 days after admission were assigned into the case group and the others were assigned into the control group, and then propensity-score matching method was used based on age, sex, and injury types. Univariate analyses and multivariate binary logistic regression analysis were used to identify the risk factors for death within 7 days after admission in these patients.Results There were 2 532 patients who met the inclusion criteria, of whom 96 patients with missing follow-up information were excluded, and 2 436 patients remained for the study. After propensity-score matching, there were 19 patients in the case group and 95 patients in the control group. The result of multivariate logistic regression analysis showed that the coma state at admission [odds ratio (OR)=9.961, 95% confidence interval (CI) (1.352, 73.363), P=0.024], perioperative body temperature<36℃ [OR=23.052, 95%CI (1.523, 348.897), P=0.024], intraoperative mean arterial pressure<60 mm Hg (1 mm Hg=0.133 kPa) [OR=12.158, 95%CI (1.764, 83.813), P=0.011], serum calcium concentraion<2.0 mmol/L [OR=33.853, 95%CI (2.530, 452.963), P=0.008], and prothrombin time [OR=1.048, 95%CI (1.002, 1.096), P=0.042] increased the risk of death within 7 days after admission.Conclusion The coma state, coagulopathy, perioperative hypothermia, intraoperative hypotension, and hypocalcemia are 5 independent risk factors for death in trauma patients after surgery under general anesthesia.

Citation： ZHANG Fei, ZHANG Yonghong, DU Juan, HUANG Xuemei, HE Ling, WANG Xiaolin, XU Suihan, LI Jun. Risk factors for death in trauma patients after surgery under general anesthesia. West China Medical Journal, 2021, 36(7): 894-899. doi: 10.7507/1002-0179.202105164 Copy

1.	Park HO, Kim JW, Kim SH, et al. Usability verification of the Emergency Trauma Score (EMTRAS) and Rapid Emergency Medicine Score (REMS) in patients with trauma: a retrospective cohort study. Medicine, 2017, 96(44): e8449.
2.	Yadollahi MT. A study of mortality risk factors among trauma referrals to trauma center, Shiraz, Iran, 2017. Chin J Traumatol, 2019, 22(4): 212-218.
3.	Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury, 2012, 43(1): 8-17.
4.	Amaefule KE, Dahiru IL, Ejagwulu FS, et al. Trauma mortality in the emergency department of a tertiary hospital in a low-income country: it’s time to walk the talks. West Afr J Med, 2020, 37(2): 131-137.
5.	Eriksson M, Brattström O, Mårtensson J, et al. Acute kidney injury following severe trauma: risk factors and long-term outcome. J Trauma Acute Care Surg, 2015, 79(3): 407-412.
6.	Kong G, Yin X, Wang T, et al. Current state of trauma care in China, tools to predict death and ICU admission after arrival to hospital. Injury, 2015, 46(9): 1784-1789.
7.	Monk TG, Bronsert MR, Henderson WG, et al. Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery. Anesthesiology, 2015, 123(2): 307-319.
8.	Chang R, Cardenas JC, Wade CE, et al. Advances in the understanding of trauma-induced coagulopathy. Blood, 2016, 128(8): 1043-1049.
9.	Keane M. Triad of death: the importance of temperature monitoring in trauma patients. Emerg Nurse, 2016, 24(5): 19-23.
10.	El MZ, Jalalzadeh H, Giannakopoulos GF, et al. Incidence and etiology of mortality in polytrauma patients in a Dutch level I trauma center. Eur J Emerg Med, 2017, 24(1): 49-54.
11.	Medam S, Zieleskiewicz L, Duclos G, et al. Risk factors for death in septic shock: a retrospective cohort study comparing trauma and non-trauma patients. Medicine, 2017, 96(50): e9241.
12.	Bech CN, Brabrand M, Mikkelsen S, et al. Risk factors associated with short term mortality changes over time, after arrival to the emergency department. Scand J Trauma Resusc Emerg Med, 2018, 26(1): 29.
13.	Bijker JB, Persoon S, Peelen LM, et al. Intraoperative hypotension and perioperative ischemic stroke after general surgery: a nested case-control study. Anesthesiology, 2012, 116(3): 658-664.
14.	Sartorius D, Le MY, David JS, et al. Mechanism, Glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med, 2010, 38(3): 831-837.
15.	Willingham MD, Karren E, Shanks AM, et al. Concurrence of intraoperative hypotension, low minimum alveolar concentration, and low bispectral index is associated with postoperative death. Anesthesiology, 2015, 123(4): 775-785.
16.	Saad AS, Wagih O, El-Shazly I, et al. The correlation between bispectral index value and Glasgow Coma Scale in isolated head trauma patients. Med J Cairo Univ, 2018, 86(6): 1533-1536.
17.	Senapathi TGA, Wiryana M, Aribawa IGNM, et al. Bispectral index value correlates with Glasgow Coma Scale in traumatic brain injury patients. Open Access Emerg Med, 2017, 9: 43-46.
18.	Sim J, Lee J, Lee JC, et al. Risk factors for mortality of severe trauma based on 3 years’ data at a single Korean institution. Ann Surg Treat Res, 2015, 89(4): 215-219.
19.	Vasudeva M, Mathew JK, Groombridge C, et al. Hypocalcemia in trauma patients: a systematic review. J Trauma Acute Care Surg, 2021, 90(2): 396-402.

1. Park HO, Kim JW, Kim SH, et al. Usability verification of the Emergency Trauma Score (EMTRAS) and Rapid Emergency Medicine Score (REMS) in patients with trauma: a retrospective cohort study. Medicine, 2017, 96(44): e8449.
2. Yadollahi MT. A study of mortality risk factors among trauma referrals to trauma center, Shiraz, Iran, 2017. Chin J Traumatol, 2019, 22(4): 212-218.
3. Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury, 2012, 43(1): 8-17.
4. Amaefule KE, Dahiru IL, Ejagwulu FS, et al. Trauma mortality in the emergency department of a tertiary hospital in a low-income country: it’s time to walk the talks. West Afr J Med, 2020, 37(2): 131-137.
5. Eriksson M, Brattström O, Mårtensson J, et al. Acute kidney injury following severe trauma: risk factors and long-term outcome. J Trauma Acute Care Surg, 2015, 79(3): 407-412.
6. Kong G, Yin X, Wang T, et al. Current state of trauma care in China, tools to predict death and ICU admission after arrival to hospital. Injury, 2015, 46(9): 1784-1789.
7. Monk TG, Bronsert MR, Henderson WG, et al. Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery. Anesthesiology, 2015, 123(2): 307-319.
8. Chang R, Cardenas JC, Wade CE, et al. Advances in the understanding of trauma-induced coagulopathy. Blood, 2016, 128(8): 1043-1049.
9. Keane M. Triad of death: the importance of temperature monitoring in trauma patients. Emerg Nurse, 2016, 24(5): 19-23.
10. El MZ, Jalalzadeh H, Giannakopoulos GF, et al. Incidence and etiology of mortality in polytrauma patients in a Dutch level I trauma center. Eur J Emerg Med, 2017, 24(1): 49-54.
11. Medam S, Zieleskiewicz L, Duclos G, et al. Risk factors for death in septic shock: a retrospective cohort study comparing trauma and non-trauma patients. Medicine, 2017, 96(50): e9241.
12. Bech CN, Brabrand M, Mikkelsen S, et al. Risk factors associated with short term mortality changes over time, after arrival to the emergency department. Scand J Trauma Resusc Emerg Med, 2018, 26(1): 29.
13. Bijker JB, Persoon S, Peelen LM, et al. Intraoperative hypotension and perioperative ischemic stroke after general surgery: a nested case-control study. Anesthesiology, 2012, 116(3): 658-664.
14. Sartorius D, Le MY, David JS, et al. Mechanism, Glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med, 2010, 38(3): 831-837.
15. Willingham MD, Karren E, Shanks AM, et al. Concurrence of intraoperative hypotension, low minimum alveolar concentration, and low bispectral index is associated with postoperative death. Anesthesiology, 2015, 123(4): 775-785.
16. Saad AS, Wagih O, El-Shazly I, et al. The correlation between bispectral index value and Glasgow Coma Scale in isolated head trauma patients. Med J Cairo Univ, 2018, 86(6): 1533-1536.
17. Senapathi TGA, Wiryana M, Aribawa IGNM, et al. Bispectral index value correlates with Glasgow Coma Scale in traumatic brain injury patients. Open Access Emerg Med, 2017, 9: 43-46.
18. Sim J, Lee J, Lee JC, et al. Risk factors for mortality of severe trauma based on 3 years’ data at a single Korean institution. Ann Surg Treat Res, 2015, 89(4): 215-219.
19. Vasudeva M, Mathew JK, Groombridge C, et al. Hypocalcemia in trauma patients: a systematic review. J Trauma Acute Care Surg, 2021, 90(2): 396-402.

West China Medical Journal

Risk factors for death in trauma patients after surgery under general anesthesia

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content