Abstract
INTRODUCTION: Firearm injuries continue to be a major cause of trauma-related morbidity and mortality worldwide. Abdominal firearm injuries are particularly critical due to the high risk of organ damage, hemorrhage, and sepsis. In trauma management, time to surgical intervention is considered one of the most decisive factors affecting survival. However, the evidence regarding the relationship between operating room (OR) access time and mortality remains inconsistent in the current literature. AIM: This study aimed to evaluate the effect of the time to emergency surgery on mortality in patients presenting with isolated intra-abdominal firearm injuries. Additionally, it sought to identify clinical, hemodynamic, and organ-specific factors associated with early mortality. METHODS: This retrospective study included 121 adult patients who presented to the Emergency Department of Adana City Training and Research Hospital between January 1, 2018, and July 31, 2024, with isolated intra-abdominal gunshot injuries and underwent emergency surgery. Demographics, comorbidities, vital signs, laboratory parameters, imaging findings, organ injuries, OR access times, and clinical outcomes were analyzed. Statistical comparisons were performed using appropriate parametric and non-parametric tests, with a significance threshold of p < 0.05. RESULTS: Of the patients, 93.4% were male, and the median age was 34 years. The overall mortality rate was 6.6%. Mortality was significantly associated with chronic ischemic heart disease, colonic injury, and intra-abdominal vascular injury (p < 0.05). Non-survivors exhibited significantly lower blood pressure, hemoglobin, hematocrit, oxygen saturation, and pH levels and significantly higher heart rate, lactate, shock index, modified shock index, CK-MB, and hs-Troponin-I values (p < 0.05). Interestingly, time to the operating room was shorter in non-survivors (p = 0.002), reflecting more severe initial clinical presentation rather than improved outcomes. CONCLUSION: In intra-abdominal firearm injuries, mortality is influenced more by the severity of organ damage and the patient's hemodynamic condition at presentation than by OR access time alone. Early recognition of critical injuries, rapid resuscitation, and timely surgical intervention remain essential for improving survival outcomes. Clinical indicators such as lactate level, shock index, and hemodynamic parameters may serve as valuable predictors of early mortality.