Study on the Outcome of Damage Control Surgery

Study on the Outcome of Damage wangle mathematical operationA RETROSPECTIVE STUDY ON THE OUTCOME OF DAMAGE CONTROL procedure IN SPMC FROM YEAR 2005 TO 2010. A RETROSPECTIVE STUDYSubmitted byChris George C. Pales, MDCo-AuthorBenedict Edward P. Valdez, MDINTRODUCTIONWHAT IS THE TOPIC ALL ABOUT?The tralatitious approach to combat injury c are is surgical exploration with definitive repair of all injuries. This approach is successful when there is limited number of injuries. These are usually performed in patients with un motionless conditions such as profound hemorrhagic shock which known to affect the over-all survival of the patient. Prolonged operative times and resolved bleeding lead to the lethal triad of coagulopathy, acidosis, and hypothermia, resulting in a mortality of about 90%.The Three stages of monetary value writerization are as followsControl of hemorrhage and contamination. Also known as bail-out cognitive process is the first stage. It is a life-saving procedure s and is rapidly performed by the surgeon. The main goal this time is to restrict blood injustice and minimizing contamination. It includes control of hemorrhage from bleeding major vessels and solid organs through packing of abdomen, deviation from intestinal anastomosis and temporary closure of abdomen.Resuscitation Once control of hemorrhage is achieved, patient is now transferred to ICU for correction of any derangement. Rewarming of the patient to avoid hypothermia, correction of blood loss, hydration and stabilization of BP, and avoiding coagulopathy.Reoperation. One patient has been stabilized, especially deep down 24-48 hours, definite procedure get out be done at operating room.WHAT IS ALREADY KNOWN ABOUT THE TOPIC?Damage control surgery is relatively new technique, about 20 years old. It is well recognized that trauma patients especially those with profound shock has a higher chance to die unessential to intra-operative metabolic failure than from the trauma itself.T he analogy of damage control surgery is to stop all haemorrhage and gastrointestinal spillage as quickly as possible while patient is having unstable vital signs at the operating room. It is coined from a U.S. Navy technique which is the capacity of a ship to absorb damage and maintain mission integrity.Speed of decision and surgery in severely injured trauma patients is the key to avoid death to patient. The well recognized essence of hypovolemic, hypothermic patient is what we call the lethal triad. It comprises the vicious cycle of hypothermia, acidosis, and coagulopathy. It is a viscous cycle that is very lethal if not recognized and controlled immediately.Patient who is stable with acceptable laboratory results, good ventilator response, non-hypothermic, are then returned to the operating for the definitive operation. (figure 1). Bowel anastomoses and colostomy maturation, definitive vascular repair, removal of hemostatic packing, and closure of abdominal fascia where is done .Figure 1.The documented mortality for the damage control approximately 50% with a documented morbidity of approximately 40% as summarized in the following table.WHAT IS NOT YET KNOWN ABOUT THE TOPIC?With the advent of modern technology and numerous studies, what is the outcome of patients undergoing Damage control surgery in SPMC from January 1, 2005 to December 31, 2010.WHAT IS THE SIGNIFICANCE OF THE STUDY?This study will give us data on the effectiveness of Damage Control Surgery done at SPMC from January 1, 2005 December 31, 2010. It will give the surgeons the data of factors that determine the outcome of damage control surgery, thus giving ways of improving healthcare management to patients.WHAT willing THIS STUDY DO?General aimThe study aims to determine the outcome of damage control surgery done in SPMC from January 1, 2005 to December 31, 2010Specific ObjectiveTo describe the demographic and clinical profile of patients who underwent damage control surgeryTo determine th e number of patients who underwent definitive surgicalprocedure after damage control surgery3. To determine the mortality rate of patients who underwent undergoing damage control surgery in SPMC from January 1, 2005 to December 2010.4. To determine the factors that affects the outcome of patients undergoing damage control surgery in SPMC from January 1, 2005 to December 2010 in terms of nature of injury, time of operation from injury and pre-operative vital signs.Patients Demographic ProfileDescribe the trauma patients harmonize to the following variablesSociodemographic characteristicsAgeSexClinical characteristicsPre-operative vital signsAssociated InjuriesGCS scoreOrgans InvolvedCo-morbiditiesDetermine the interventions and clinical outcome of patientsDuration of OperationOperations performeddeathrate rateRe-operation performedDispositionFigure 1. Conceptual FrameworkMETHODOLOGYGeneral DesignThe study employed is a retrospective, descriptive study design. Chart follow of all pat ients who underwent damage control surgery during January 1, 2005 to 2010 will be done by the author with the permission of the medical records section and the hospital research committee. positionThe study will be will be conducted at Southern Philippines medical exam piazza, a tertiary hospital in Davao City in June 2013.PARTICIPANTS comprehension CRITERIAThis study will include all patients admitted and underwent Damage control surgery at Southern Philippines Medical center in 2005-2010. Damage control surgery includes resection of major injuries to the gastrointestinal tract without re-anastomosis control of hemorrhage through peri-hepatic packing and temporary closure of abdomen and use of an alternate closure of a cervical incision, thoracotomy, laparotomy, or site of exploration of an extremity.EXLCLUSION CRITERIANoneSAMPLING PROCEDURESThe study subjects (target population) of this research are the patients admitted and underwent Damage control surgery at Southern Philippin es Medical Center in 2005-2010.RandomizationNoneDATA GATHERINGDependent VariableNumber of Damage Control Surgery from 2005-2010Main outcome measures and other reliant variablesNumber of patients who expired and number of patients survived.Independent VariablesAge and SexNature of injuryTime of intervention from time of injuryPre-Operative vital signsGlasgow coma cuticleOrgans involvedDuration of OperationAvailability of BloodInterventionsNoneData Handling and AnalysisAll data will be computed as to the mortality rate by computing the number of patients who expired to the total number of patients who underwent Damage control surgery.Furthermore, determination of mortality will be computed by computing the ratio of mortality as of Age and Sex, Nature of injury, Time of operation from injury and Pre-op vital signs, Duration of Operation, Availability of blood, Organs involved.ETHICAL CONSIDERATIONS morality ReviewThe proponent of the study will secure an approval from the Cluster Eth ics Research Committee of The Southern Philippines Medical Center prior to doing the research. A similar approval is also secured from the part of Surgery of the same institution with the approval of a consultant in-charge.PrivacyNo phone calls or plaza visits as follow up to participants.ConfidentialityThe detectives will not disclose the identities of the patients at any time. The data obtained during the study will be under the Department of Surgery of Southern Philippines Medical Center and will be kept in confidentiality.Extent of Use of Study DataThe data collected by the researcher will only be used to answer the objectives of stated in the protocol. Data will be available to others as a finished paper. typography and ContributorshipThe main proponent of the study is the main author and researcher of the study. Consultant guidance and support will be provided Dr. Benedict Valdez, head of Section of Trauma, Department of Surgery, SPMC. He is the co-author who will aide in t he study design. A professional statistician will help in the study write-up and data analysis. The author and co-author gives consent to use the data collected for further research.Conflicts of InterestThe main proponent and the co-authors declare no conflict of interest.PublicationThe research will be submitted for national and international publication groups and may be chosen for publication. In all portions in the paper, the author and co-authors will be duly acknowledged. keepThe main proponent of the study is using personal funds to conduct the study. Funding of the braces will depend on the patients and their guardians.REFERRENCESSchwartz book of Surgery eighth Edition by F. Charles BrunicardiTrauma, Fifth Edition by David Feliciano, MDA logical approach to trauma Damage control surgery Shibajyoti Ghosh, Gargi Banerjee, Susma Banerjee, D. K. ChakrabartiDepartment of Surgery, R. G. Kar Medical college, West Bengal, India.Townsend Sabiston Textbook of Surgery, 17th ed., Copyr ight 2004 ElsevierCombat Damage Control Resuscitation Today and Tomorrow Colonel Lorne H. Blackbourne, MDUS Army Institute of Surgical Research, 3400 Rawley E. Chambers Ave. Fort surface-to-air missile Houston, TX 78234USADamage Control Beyond the Limits of the Abdominal Cavity. A ReviewMaeyane S. Moeng, MB, BCh, FCS(SA),1 Jerome A. Loveland, MB, BCh, FCS(SA),2 and Kenneth D. Boffard, BSc(Hons), MB, BCh, FRCS, FRCS(Edin), FRCPS(Glas), FCS(SA), FACS, FCS(SA)Feasibility of Damage Control Surgery in the Management of Military Combat CasualtiesBen Eiseman, MD, Ernest Moore, MD, Daniel Meldrum, MD, Christopher Raeburn MDDUMMY TABLESTABLE 1 Demographics and Clinical Characteristics.TABLE 2 OUTCOMETABLE 3 BUDGETTABLE 4 TIMETABLECURRICULUM VITAEName Chris George C. Pales holler Unit 303, Palmetto Place, Maa road, Davao CityTelephoneCell 09238060856PhoneEmail emailprotected/emailprotectedPersonal InformationDate of Birth April 9, 1983Place of Birth Koronadal City, South CotabatoCitizenship Filipino place MarriedGender MaleEducationElementary Kipalbig Elementary School, Kipalbig, Tampakan, South Cotabato (SY 1990-1996)High School Notre Dame of Marbel University, Koronadal, South Cotabato (SY 1996-2000)Colllege West Visayas State University, Iloilo City (SY 2000-2004)medicament West Visayas State University, Iloilo City (SY 2004-2008)DATA COLLECTION SHEETA RETROSPECTIVE STUDY ON THE OUTCOME OF DAMAGE CONTROL SURGERY IN SPMC FROM YEAR 2005 TO 2010. A RETROSPECTIVE STUDYChris George C. Pales, MD/Benedict Edward P. Valdez, MDHospital AgeSexNATURE OF INJURYStab wound______Gunshot wound______ point-blank Trauma______Penetrating Injuries______VITAL SIGNS ON ADMISSIONBPHRRRTEMPGCS scoreTIME OF ARRIVAL SINCE INJURY_______ Minutes_______ Hours_______ DaysDURATION OF OPERATIONUNITS OF birth TRANSFUSEDINTRA-OP VITAL SIGNSBPCRORGANS INVOLVEDRE-OPERATION DONE FOR DEFINITIVE PROCEDURE?____Yes____NoNUMBER OF HOSPITAL STAYDISPOSITION______DISCHARGED IMPROVED______DIEDCAUSE OF DEATH