The Severity Of Pre-operative Acidosis Affects Mortality In Abdominal Trauma Patients Conducted By Laparotomy Exploration At H. Adam Malik Hospital Medan

Feb 27, 2025 by ADMIN 154 views

The Severity of Pre-operative Acidosis Affects Mortality in Abdominal Trauma Patients Conducted by Laparotomy Exploration at H. Adam Malik Hospital Medan

Abdominal trauma is a type of injury that is ranked third highest among all trauma events, with approximately 25% of cases requiring surgery to manage the condition. The mortality rate in trauma patients can increase due to the "Lethal Triad of Death," a combination of hypothermia, coagulopathy, and metabolic acidosis. This study aims to examine the relationship between the severity of pre-operative acidosis and mortality rates in patients who experience abdominal trauma and undergo laparotomy exploration procedures at H. Adam Malik Hospital Medan.

Abdominal trauma is a significant public health concern, with a high mortality rate associated with it. The "Lethal Triad of Death" is a critical factor in the increased mortality rate, as it can lead to a cascade of events that ultimately result in patient death. Metabolic acidosis, a component of the lethal triad, occurs when the body's metabolism shifts from aerobic to anaerobic, resulting in the buildup of lactic acid. This condition can have severe consequences, including organ failure and death.

Pre-operative Acidosis and Mortality

Pre-operative acidosis is a critical factor in the management of abdominal trauma patients. The severity of pre-operative acidosis can have a significant impact on patient outcomes, including mortality. This study aims to examine the relationship between the severity of pre-operative acidosis and mortality rates in patients who experience abdominal trauma and undergo laparotomy exploration procedures at H. Adam Malik Hospital Medan.

This study uses an analytic descriptive design with a retrospective approach. The sample studied consisted of 64 cases obtained from the medical records of patients diagnosed with abdominal trauma and who had undergone laparotomy exploration procedures in the Digestive Surgery Division of H. Adam Malik Medan Hospital between January 2011 and December 2013. The data obtained were analyzed using the Chi Square test to determine the significant relationship between the variables studied.

In this study, of the total 64 cases of abdominal trauma undergoing laparotomy exploration, there were 25 cases that ended with mortality, which was equivalent to a mortality rate of 39.1%. Of the overall cases, 61 patients (95.3%) underwent laparotomy exploration, while 3 cases (4.7%) were carried out using the Damage Control Surgery method. The severity of measured acidosis shows that 55 cases (85.9%) experienced mild acidosis, while 9 cases (14.1%) underwent severe acidosis. The results of Chi Square's analysis showed a significant relationship between the severity of pre-operative acidosis and mortality in abdominal trauma patients undergoing laparotomy exploration, with a value of P = 0.001.

From the research conducted, it can be concluded that there is a significant relationship between the severity of pre-operative acidosis and mortality rates in patients with abdominal trauma undergoing laparotomy exploration at H. Adam Malik Hospital Medan. This finding highlights the importance of monitoring and handling metabolic acidosis before surgery, which can contribute to reducing mortality rates in managing abdominal trauma.

The results of this study have important implications for clinical practices in hospitals. With an increase in understanding of the effect of pre-operative acidosis on clinical results, doctors and other medical personnel can focus more on efforts to handle the patient's condition before surgery. This includes management of body temperature, electrolyte regulation, and intervention to improve the patient's acid-base status. With the right preventive measures, it is expected to reduce the risk of complications and increase the level of patient safety during surgical procedures.

Based on the findings of this study, the following recommendations are made:

Monitoring of pre-operative acidosis: Healthcare providers should closely monitor patients' acid-base status before surgery to identify any potential issues.
Management of body temperature: Patients should be managed to maintain a stable body temperature to prevent hypothermia.
Electrolyte regulation: Patients should be managed to maintain stable electrolyte levels to prevent coagulopathy.
Intervention to improve acid-base status: Healthcare providers should intervene to improve patients' acid-base status before surgery to prevent metabolic acidosis.

By implementing these recommendations, healthcare providers can reduce the risk of complications and improve patient outcomes in abdominal trauma patients undergoing laparotomy exploration procedures.

This study has several limitations, including:

Retrospective design: The study used a retrospective design, which may limit the generalizability of the findings.
Small sample size: The study had a small sample size, which may limit the power of the analysis.
Limited data: The study used data from a single hospital, which may limit the generalizability of the findings.

Future research should aim to:

Validate the findings: Future studies should aim to validate the findings of this study using a larger sample size and a prospective design.
Examine the effect of pre-operative acidosis on other outcomes: Future studies should aim to examine the effect of pre-operative acidosis on other outcomes, such as morbidity and length of stay.
Develop guidelines for the management of pre-operative acidosis: Future studies should aim to develop guidelines for the management of pre-operative acidosis in abdominal trauma patients.
Frequently Asked Questions (FAQs) about the Severity of Pre-operative Acidosis and Mortality in Abdominal Trauma Patients

A: Pre-operative acidosis is a condition where the body's acid-base balance is disrupted before surgery. This can occur due to various factors, including trauma, infection, or other medical conditions.

A: The severity of pre-operative acidosis has been shown to have a significant impact on mortality rates in abdominal trauma patients. Studies have found that patients with severe pre-operative acidosis are at a higher risk of mortality compared to those with mild acidosis.

A: The risk factors for pre-operative acidosis in abdominal trauma patients include:

Trauma severity: Patients with more severe trauma are at a higher risk of developing pre-operative acidosis.
Age: Older patients are at a higher risk of developing pre-operative acidosis.
Comorbidities: Patients with underlying medical conditions, such as diabetes or kidney disease, are at a higher risk of developing pre-operative acidosis.
Infection: Patients with infections, such as sepsis, are at a higher risk of developing pre-operative acidosis.

A: Pre-operative acidosis can be managed through various interventions, including:

Fluid resuscitation: Patients may receive fluids to help restore their blood volume and improve their acid-base balance.
Electrolyte replacement: Patients may receive electrolyte replacement therapy to help restore their electrolyte balance.
Buffer therapy: Patients may receive buffer therapy to help restore their acid-base balance.
Surgical intervention: In some cases, surgical intervention may be necessary to address the underlying cause of the pre-operative acidosis.

A: The findings of this study have important implications for clinical practice. Healthcare providers should closely monitor patients' acid-base status before surgery to identify any potential issues. Patients should be managed to maintain a stable body temperature, electrolyte levels, and acid-base status before surgery. By implementing these recommendations, healthcare providers can reduce the risk of complications and improve patient outcomes in abdominal trauma patients.

A: This study has several limitations, including:

Retrospective design: The study used a retrospective design, which may limit the generalizability of the findings.
Small sample size: The study had a small sample size, which may limit the power of the analysis.
Limited data: The study used data from a single hospital, which may limit the generalizability of the findings.

A: Future research should aim to:

Validate the findings: Future studies should aim to validate the findings of this study using a larger sample size and a prospective design.
Examine the effect of pre-operative acidosis on other outcomes: Future studies should aim to examine the effect of pre-operative acidosis on other outcomes, such as morbidity and length of stay.
Develop guidelines for the management of pre-operative acidosis: Future studies should aim to develop guidelines for the management of pre-operative acidosis in abdominal trauma patients.