Analysis of the Major Factors Affecting the Course of the Immediate Postoperative Period with Stab and Cut Wounds of the Heart in a Multidisciplinary Surgical Hospital

Abstract

Introduction. Heart injury can be attributed to one of the most severe traumas. According to the data presented in the literature, such wounds are not common and account for 5-7% of the total number of wounds that penetrate the pleural cavity. However, despite rare incidence, such injuries are accompanied by a fairly large number of complications reaching 47.9%, and lethality at the level of 34.1%. This is due to the fact that diagnosis of such injuries causes some difficulties, and various methods including thoracoscopy are currently proposed to solve them. The issue of diagnostics and treatment of heart injuries has received much attention in the literature, but this problem has not been completely solved, since there are many factors that influence the course of the immediate postoperative period with such injuries.
 The aim of the study was to analyse major factors that affect the course of the immediate postoperative period in patients with stab-cut heart injuries.
 Materials and methods. The study involves a retrospective analysis of the immediate postoperative period of 86 patients operated for a penetrating chest wound with the heart and pericardium wound. Patients were treated in the surgical department of "Emergency Medical Hospital of Engels" from 1988 to 2019. Of the total number of patients, 76 (88,3%) were male and 10 (11,6%) were female. It should be noted that the majority of males - 47 - were in a state of alcoholic intoxication of varying severity.
 Results. According to the analysis, out of 86 patients admitted to the medical facility on an emergency basis, 73,2% were included in group A, 26.7% of the wounded were included in group B. The data demonstrated that the vast majority of the wounded were delivered as soon as possible from the moment of injury, which could not but affect the course of the immediate postoperative period. It should be noted that 72,1% of the wounded were delivered by ambulance, 27,9% of patients by the meeting traffic. In the group of wounded who were delivered by the meeting transport, and who were provided first aid by non-medical workers, the results were significantly worse. In patients of this group, first aid was provided to only 13,9% of the wounded, in all cases it was wound processing and the aseptic bandage application, and in 10.5% of cases the first aid can be described as inadequate. When analyzing the course of the immediate postoperative period, we found that the development of complications was noted in 45,3% of patients. The distribution of the number of complications by groups showed that the largest number was 25,6% in group B, in group A complications were noted in 19,8% of cases. Further analysis showed that the number of complications in two groups directly depends on the severity of the condition of the wounded at the time of admission. The main complication that developed in the postoperative period in operated patients was purulent septic complications, noted in 22,1% of the wounded. The largest number of complications - 12.8% - was detected in group A, in group B such complications developed in 9.3% of cases. Of the total number of patients admitted with heart injuries, 23.2% of patients died. The mortality rate was 6.9% in group A, and 16.3% in group B.
 Conclusion. Based on the analysis, it can be concluded that the heart injury is accompanied by a large number of complications in the immediate postoperative period - 45.3% and deaths - 23.2%. Among the major factors contributing to the development of complications and deaths are the following:
 
 Timely, complete and competent assistance at the pre-hospital stage.
 The condition and severity of damage to the wounded at the time of delivery.
 The use of Damage Control tactics in cases where the condition of the wounded person at the time of admission is severe or extremely severe.