Vascular Repair after Firearm Injury is Associated with Increased Morbidity and Mortality
Jeffrey J. Siracuse, M.D., Thomas W. Cheng, M.S., Alik Farber, M.D., Thea James, M.D., Yi Zuo, M.P.H., Jeffrey A. Kalish, M.D., Douglas W. Jones, M.D., Bindu Kalesan, Ph.D..
Boston University/Boston Medical Center, Boston, MA, USA.
OBJECTIVES: Firearm injuries have high morbidity and mortality. Presentation of injuries requiring concurrent vascular repairs and its outcomes are unclear. Our study’s objectives are to characterize injury details, and assess mortality and morbidity following vascular repair.
METHODS: The Nationwide Inpatient Sample was queried from 1993-2014 for all firearm injuries. ICD-9 codes were used to identify firearm injuries and those who also underwent a vascular repair. Multivariable analysis was performed to assess the effect of concurrent vascular repair on outcomes.
RESULTS: There were 648,662 firearm injuries identified - 63,973 (9.9%) involved vascular repair. Overall, 88.7% of patients were male and Medicaid was the most common insurance (40.2%). Intents were assault/legal intervention (60%), unintentional (24.2%), and suicide (8.6%). Patients undergoing vascular repair were younger, more often black race, male sex, on Medicaid, and with lower household income (all P<.005). Patients who underwent vascular repair compared to those without was more frequently for assault/legal intent (66.6% vs. 59.3%), abdomen/pelvis (33.6% vs. 23.1%) and extremity injuries (40.8% vs. 29.5%), and had an elevated new injury severity score (NISS) (all P<.005). Vascular repair was more frequently performed at urban, teaching, and large hospitals (P<.005).
Overall mortality rate was 2.2% - patients who underwent vascular repair had a higher mortality rate compared to those without (5.51% vs. 1.98%, P<.001). Patients with vascular repair had higher rates of acute renal failure (3.1% vs. .8%), venous thromboembolic events (.5% vs. .3%), pulmonary-related events (.6% vs. .28%), cardiac-related events (.8% vs. .2%), sepsis (1.4% vs. .5%), and any complication (5.7% vs. 2%) (all P<.0001). Vascular repair was independently associated with mortality (OR 2.68, 95% CI 2.43-2.95, P<.0001). Age greater than 46 years (OR 2.01, 95% CI 1.71-2.35, P<.0001), male sex (OR 1.15, 95% CI 1.05-1.25, P=.003), self-pay/no insurance (OR 1.6, 95% CI 1.47-1.75, P<.0001), suicide (OR 3.73, 95% CI 3.36-4.13, P<.0001), unintentional intent (OR 1.12, 95% CI 1.03-1.22, P<.0001), head/neck injury (OR 13.9, 95% CI 12.5-15.6, P<.0001), Northeast region, and NISS >4 were independently associated with in-hospital mortality. Vascular repair was independently associated with any complication (OR 2.12, 95% CI 1.98-2.28, P<.0001).
CONCLUSIONS: Firearm injuries with vascular repair were independently associated with higher injury severity score and mortality. A majority of vascular repairs were performed for injury to the abdomen/pelvis, extremity, and assault/legal intent.
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