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Does a time threshold exist for bladder repair after which outcomes worsen? A Trauma Quality Improvement Program
Yu-Chi Kuo1, Pei-Hua Li1, Ting-An Hsu1
1Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
Surgery
|February 9, 2023
Summary
Delayed surgical repair for bladder injuries beyond 24 hours increases infection and acute kidney injury risks. Prompt intervention is crucial for better patient outcomes in bladder trauma cases.
Area of Science:
- Trauma Surgery
- Urology
- Patient Outcomes
Background:
- The optimal timing for surgical intervention in bladder injuries remains unclear.
- This study investigates the impact of time to surgery on patient outcomes following bladder injury.
Purpose of the Study:
- To assess the effect of delayed surgical repair on outcomes in patients with bladder injuries.
- To determine if surgical repair within 24 hours improves patient outcomes compared to later intervention.
Main Methods:
- Retrospective analysis of 1,507 patients with bladder injuries from the Trauma Quality Improvement Program (2017-2019).
- Comparison of outcomes (mortality, infection, AKI, LOS) between patients undergoing repair within vs. after 24 hours of arrival.
- Evaluation of the association between time to surgical repair and patient outcomes.
Main Results:
- Patients undergoing repair >24 hours post-arrival had significantly higher rates of infection (5.6% vs 2.5%) and acute kidney injury (7.8% vs 1.8%).
- Delayed repair (>24 hours) was associated with a longer postoperative length of stay (16.0 vs 12.3 days).
- Repair time >24 hours increased infection/AKI risk (OR=1.823) but did not significantly impact mortality.
Conclusions:
- Surgical repair of bladder injuries more than 24 hours after emergency department arrival is linked to poorer outcomes.
- Delayed intervention may lead to increased infection rates, acute kidney injury, and prolonged hospital stays.
- Prompt surgical management is recommended for patients with bladder injuries to mitigate adverse outcomes.
