::INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES::

CODEN : IAJPBB
issn 2349-7750

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TITLE:

OUTCOME OF EMERGENCY VASCULAR REPAIRS DONE BY GENERAL SURGEONS IN TERMS OF COMPLICATIONS, HOSPITAL STAY AND MORTALITY

AUTHORS:

Sidra Aslam, Tehreem Rubab, Anam Ayub,

ABSTRACT:

Natural calamities and civil wars have increased worldwide. There is huge burden of vascular surgical diseases and general surgeons are helping vascular surgeons to reduce surgical workload. Objective: bTo determine outcome of emergency vascular repairs done by general surgeons in terms of complications, hospital stay and mortality Study Design: Retrospective study Setting: General Surgery Emergency Department, Allied Hospital, Faisalabad. Methodology: All patients of all age groups who required emergency vascular surgery, diagnosed by consultant surgeon at surgical emergency were included. Operations were performed after pre-anesthetic evaluation by consultant general surgeons. Variables including injury type, vessel injuries, injury severity score (ISS), surgical repair done, hospital stay, complications and mortality, were recorded from old data. Various complications after the surgery were compared with the type of repair done, age group and time till presentation after injury. The p-value <0.05 was considered significant. Limb amputation or mortality was taken as poor outcome. Results: Retrospective data showed 135 patients with mean age 28.8 + 11.5 years (14 -63) most of which were males (127 of 135) and 56% had road traffic accidents, 19% gunshot injuries and 25% injuries from sharp objects. Only 6% patients presenting within 30 mins of injury and around 50% patients reached within 3 hours. Three major peripheral arteries injured were brachial 38%, popliteal 40% and femoral (21%) with more than half with complete transection (55%). Vascular repairs done were primary anastomosis (33%), reverse saphenous vein graft (RSVG) 50.4%, embolectomy (3%) and amputation (13%). Limb salvage rate and mortality was 74.8% and 4.4%, respectively. Complications occurred in 38/135 (28.1%) cases with wound infection (18%) and myonecrosis (6.7%) on top. No complications after vascular repairs done by general surgeons were seen in 71.9% cases. Factors leading to poor outcome/complications were GCS <12 (p=0.01), referred case (p=0.04), significant bleeding (p=0.004), Hb <9 at presentation (p=0.001), bone fracture (p=0.01), involvement of lower limb and late presentation (p=0.003). Conclusion: Late presentation in hospital is the major modifiable factor improvement of which can lead to better outcome, apart from the early and proper surgical intervention. The outcome of this study revealed preventable causes of limb loss and mortality in emergency vascular repair cases done by general surgeons. Keywords: Vascular surgery, artery repair, venous graft, vascular anastomosis,