War-related emergency laparotomy and thoracotomy injuries and their operative outcomes in a makeshift surgical unit in Gaza during the 2023 - 2025 war.

Abstract

The 2023-2025 war on Gaza has severely impacted healthcare infrastructure, necessitating the establishment of makeshift facilities to manage war-related injuries. This study evaluates the outcomes and resource accessibility for emergency laparotomy or thoracotomy injuries in a makeshift trauma surgery unit in Gaza during the war. A prospective cohort study was conducted from July 16 to August 31, 2024, including consecutive patients with war-related injuries who underwent emergency laparotomy or thoracotomy, with 30-day follow-up. Obstetrics and gynecology facilities were repurposed as a trauma surgery unit. Outcomes included mortality, complications, unplanned reoperations, and resource accessibility. Among 79 patients, 84% (66/79) sustained injuries due to blast mechanism, of which 53% (35/66) were prehospital reported as caused by airstrikes. 94% (74/79) underwent emergency laparotomy, 9% (7/79) underwent emergency thoracotomy, and 3% (2/79) underwent both surgeries. In-hospital mortality was 32% (25/79). Postoperative complications occurred in 69% (51/74), with surgical site infections being the most common (58%, 43/79). Additionally, 15% (11/74) required an unplanned return to the operating theater. Only 5% (4/79) had access to preoperative CT imaging. 62% (49/74) of patients were treated postoperatively in corridors or outdoors. 56% (24/43) of patients were lost to follow-up by day 30. This study describes severe truncal trauma managed in a makeshift civilian facility with limited medical resources, where non-surgical hospital spaces were repurposed for trauma care. High rates of mortality and postoperative complications were observed, and basic surgical resources were unavailable for the majority of patients. A trauma database was able to be maintained despite the constraints of a humanitarian crisis.