Syrian civil war victims reach Turkish hospital for surgery

Last Updated: 2015-06-30

By Will Boggs MD

NEW YORK (Reuters Health) - Between 2011 and 2012, 159 patients with civil war injuries in Syria required surgery at a hospital in neighboring Turkey.

"Unfortunately, nearly none of the injured patients was transferred to us with any information," Dr. Seckin Akkucuk, from Medicine School of Mustafa Kemal University, Hatay, Turkey, told Reuters Health by email. "Rarely if there were multiple entrances of injured patients, we were notified. And even then, the information was from our country's ambulance services."

Of the 159 patients admitted by Dr. Akkucuk's team, 79 had already been primarily operated in Syria, and 43 of these required no further surgery. This left 80 patients who received their first surgery in Turkey and 36 that underwent further surgery in Turkey.

Transfer time from the battlefield averaged 6.28 hours, though previously operated patients arrived a median 58.11 hours after their first surgical intervention.

Findings were negative in six of the reoperated patients, but 12 had undisclosed abdominal packing and 18 had hollow visceral injury or anastomotic leaks with gross intra-abdominal contamination, according to the June 8 Journal of the Royal Army Medical Corps online report.

The most common surgical procedures were stomas, with 24 patients receiving ileostomy/jejunostomy and 23 receiving colostomy and/or other surgical interventions.

Eight patients with failed intestinal surgeries developed septic complications, and five of them died due to multi-organ failure secondary to the sepsis.

Two of seven women and 21 of 109 men died. A third of the patients who were transferred after surgery in Syria died, compared with 13.7% (11/80) who were primarily treated in Turkey.

"To avoid casualties, adequate medical organization is required even if the war occurs in your neighbor," the researchers concluded. "Some precautions should be taken such as transformation of nearby civilian hospitals to military ones to decrease transfer time and to perform adequate interventions. Trauma experienced surgeons should be staffed, complete drug and medical supplies provided and appropriate intensive care units should be designed in hospitals of border cities until the end of the war."

"Damage control principles should be the most important point in patients with potentially lethal injuries to avoid casualties," Dr. Akkucuk said.

To care for these patients, Dr. Akkucuk said, "We had to add additional surgical units (for about 70, maybe 80 beds and 10 intensive care unit beds) and nearly 30 new personnel were staffed during this period. The costs were about 30% of our institution's monthly income ($350,000-$400,000)."

Army surgeon Dr. Christopher E. White from San Antonio Military Medical Center, San Antonio, Texas, told Reuters Health by email, "Mortality fits a first order decay curve (like a radioactive isotope - but the x-axis should be in minutes - or seconds). The most important aspect of combat casualty care is getting the wounded to a surgeon where s/he stops the bleeding/contamination. In a setting like Syria (or even South Texas) there isn't a good air-evac system. You're more than likely going to leave the wounded on the battlefield too long and end up in the tail of the mortality curve."

"Damage-control surgery (stopping the bleeding/contamination/leave the belly/chest, etc. open) should be the rule at first laparotomy on a battlefield, especially if you're going to transport to a higher level of care," Dr. White said.

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/1FNvACc

J R Army Med Corps 2015.