Risk factors for intra-abdominal complications in staged treatment of penetrating abdominal wounds

BACKGROUND: Penetrating abdominal wounds with internal organ injuries are classified as severe injuries and are characterized by complications developing in 77% of survivors, with the proportion of complications directly related to abdominal wounds and surgical interventions being 48%. AIM: To determine the causes of intra-abdominal complications and assess the relative contribution of systemic and technical factors in penetrating abdominal wounds under staged treatment conditions in a modern military conflict. METHODS: A retrospective analysis of medical records of wounded patients with penetrating abdominal wounds was conducted. Two groups were formed upon admission to the 5th level of staged care: group 1 comprised wounded patients without intra-abdominal complications, group 2 comprised wounded patients with such complications. Considering the sample heterogeneity, specific features of the formed groups, and the primary hollow organ sealing technique, statistical analysis using multiple logistic regression was performed to identify predictors and evaluate their impact on intra-abdominal complication development. RESULTS: The sample included 198 wounded patients with penetrating abdominal injuries. The development of intra-abdominal complications was recorded in 105 patients, accounting for 249 different intra-abdominal complications. The severity of the initial injury and delays in diagnosing hollow organ injuries are major independent risk factors necessitating increased attention during triage and initial examination using objective diagnostic methods. Optimizing the evacuation scheme, aimed at minimizing the number of staged interventions and reducing the time to primary laparotomy, is a critically important direction for reducing the frequency of intra-abdominal complications. CONCLUSION: The main modifiable risk factors for intra-abdominal complications in penetrating abdominal injuries under staged treatment conditions are the presence of an unsanitized focus of intra-abdominal infection during evacuation stages, delay in performing the first laparotomy beyond 24 hours, and the number of surgical interventions performed prior to evacuation to the 5th level of medical care.