Where should the damage control surgery be performed, at the nearest health center or at a fully equipped hospital?
BACKGROUND
Transport of casualties from a combat area to a fully equipped hospital where all techniques of damage control surgery (DCS) can be performed requires a great deal of time. Therefore, prior to transport, prompt control of hemorrhage and contamination should be achieved, and resuscitative procedures should be performed at the nearest health center. The aim of the present study was to investigate the effect of the location at which DCS was performed on rates of mortality.


METHODS
The present retrospective study included 51 combat casualties who underwent DCS at the present clinic or at hospitals nearest the combat area due to high kinetic energy gunshot injuries to the abdomen between 2010 and 2015. Patients were evaluated in terms of acidosis, hypothermia, coagulopathy, and mortality.


RESULTS
Patients were divided into 2 groups depending on the location where the first step of DCS was performed: (1) at the present hospital or (2) at other hospitals. Group 1 comprised 26 patients (51%), and Group 2 comprised 25 (49%). Total mortality occurred in 23 (45.1%) patients, including 15 (57.7%) patients in Group 1 and 8 (32%) in Group 2. In Group 1, mean time from injury to hospital admission was longer, and deep acidosis, hypothermia, and coagulopathy were more marked.


CONCLUSIONS
Initial surgical control of hemorrhage and contamination in patients injured by high kinetic gunshots should be promptly achieved at the nearest health center. In this way, acidosis, hypothermia, and coagulopathy can be prevented, and the risk of mortality can be reduced.
Department of General Surgery, Mustafa Kemal University Faculty of Medicine, Hatay-Turkey. drmustafaugur@gmail.com.
Mustafa
M
Uğur
Department of General Surgery, Mustafa Kemal University Faculty of Medicine, Hatay-Turkey.
Seçkin
S
Akküçük
Department of General Surgery, Süleyman Demirel University Faculty of Medicine, Isparta-Turkey.
Yavuz Savaş
YS
Koca
Department of General Surgery, Mustafa Kemal University Faculty of Medicine, Hatay-Turkey.
Cem
C
Oruç
Department of General Surgery, Mustafa Kemal University Faculty of Medicine, Hatay-Turkey.
Akın
A
Aydoğan
Department of General Surgery, Mustafa Kemal University Faculty of Medicine, Hatay-Turkey.
Erol
E
Kılıç
Department of General Surgery, Mustafa Kemal University Faculty of Medicine, Hatay-Turkey.
İbrahim
İ
Yetim
Department of General Surgery, Mustafa Kemal University Faculty of Medicine, Hatay-Turkey.
Muhyittin
M
Temiz
D000328:Adult; D006470:Hemorrhage / Q000601:surgery; D006801:Humans; D008297:Male; D012151:Resuscitation; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000458:organization & administration*; D014218:Triage / Q000458:organization & administration*; D014421:Turkey / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000601:surgery*