For many years, anesthesiologists have played crucial roles in various capacities during natural disasters.Reference Kuza and McIsaac¹ However, articles detailing the assistance provided by anesthesiologists to victims typically focus on initial field interventions. The roles of anesthesiologists, though, are not confined to the earthquake zone. Their responsibilities extend to triage in emergency departments, operating rooms, and intensive care units (ICUs). In this article, we aim to evaluate the patients admitted to the operating room of a Level 3 hospital, Turkey’s largest, located a significant distance from the earthquake site, from different perspectives.

This report was designed as descriptive cross-sectional research, and relevant data on earthquake victims were collected from electronic Ankara Bilkent City Hospital records and anesthesia charts. Unfortunately, data regarding many patients’ interventions in the earthquake zone were not accessible.

The information resulting from the statistical analysis of data was presented as percentages. All data were statistically analyzed using SPSS v. 23 software (Statistical Package for the Social Sciences, IBM Corp., Armonk, NY, USA). Continuous variables were shown as median (Min-Max).

Following the earthquake, a total of 231 patients were admitted to our hospital’s general operating room for 650 procedures. A single patient underwent up to 14 different surgeries. Of the total patients, 116 were male and 115 were female. The average age was calculated to be 35 years, with the oldest patient being 88 years old. When evaluated according to the ASA criteria, 27 patients were classified as ASA I, 122 patients as ASA II, 56 patients as ASA III, and 26 patients as ASA IV.

Ten percent of the patients underwent surgery within the first week. The number of patients who had previously been operated on in the earthquake zone was 80 (34.6%). The remaining patients were admitted for surgery for the first time. The last case entered the operating room 63 days after the earthquake initially occurred.

When evaluating the types of anesthesia applied in the operating room, it was found that general anesthesia was administered 577 times, spinal anesthesia 56 times, and regional blocks were performed 17 times in various locations.

The majority of the patients operated on in the operating room were trauma patients requiring debridement, accounting for 74.02% (n = 171) of cases. Among the trauma patients, the most frequently injured area was the right lower extremity, comprising 57.57% (n = 133) of those cases.

During the intraoperative period, the number of patients who received blood or blood products was 32 (13.8%). In 1 particular surgery, the maximum number of products given included 4 units of red blood cell suspension and 4 units of fresh frozen plasma.

A total of 32 patients were operated on with a preliminary diagnosis of Crush syndrome, and among these patients, 18 (56.25%) required dialysis. Following surgery, 42 patients (18.18%) were transferred to the ICU for further monitoring. Of these ICU patients, 35 (83.3%) required mechanical ventilation. Out of the 231 patients admitted to the operating room, 9 (3.89%) could not be resuscitated, despite the interventions performed. Among these 9 patients, 5 died due to septic shock, 3 due to severe electrolyte disturbances from advanced Crush syndrome, and 1 due to an intracranial complication.

In this report, we present descriptive results regarding the anesthetic approach for 231 patients who were treated in the operating room of a tertiary hospital located away from the earthquake zone following the devastating earthquake centered in Kahramanmaraş, which affected 11 cities and ranks among the most significant earthquakes in recent years. A total of 650 procedures were performed on these 231 patients, with 1 patient requiring up to 14 entries to the operating room. Approximately 74.02% of the patients underwent debridement secondary to trauma. General anesthesia was the preferred type of anesthesia in the operating room, used in 577 cases. Despite all interventions, 3.89% of the patients did not survive.

The period beginning the first week after initial on-site interventions and triage following natural disasters like earthquakes constitutes the most intensive days when victims require advanced medical care. During this time, injuries caused by crushes that can lead to Crush syndrome necessitate fluid balance management and often require higher-level surgical interventions. Patients from hospitals near the earthquake zone begin to be transferred to hospitals located in more distant areas.

In the Marmara region of Turkey, a 7.4 magnitude earthquake struck at 03:02 local time on August 17, 1999, and lasted for 45-50 seconds. In a reported study from a nearby regional hospital where the victims were transported, the authors noted that 645 patients were admitted to the emergency department. The hospitalization rate was 52% (330/645), the discharge rate from the emergency department was 34% (n = 220), and the transfer rate to another hospital was 13% (n = 87). Mortality rates were 1% (n = 8) in the emergency department and 15% (n = 50) among hospitalized patients. Among 176 patients with extremity injuries, 56 (31.8%) had lower extremity injuries. Of the hospitalized patients, 110 were diagnosed with Crush syndrome, and 60 (54.5%) of these patients required dialysis. The mortality rate was 21% among the patients with Crush syndrome, whereas it was 35% among those who required hemodialysis. The most frequently needed surgical procedure was fasciotomy (n = 130).Reference Bulut, Fedakar and Akkose²

In October 2020, a 6.6 magnitude earthquake struck the Aegean region of Turkey at 15:51 local time. A study by Çağıran et al., which evaluated 152 patients through the emergency department, reported that 25.7% of the patients died before reaching the hospital. The surviving 113 victims, with an average age of 38.13 years, were admitted to the hospital. It was determined that 11.8% of the patients had lower extremity fractures. Additionally, 6 patients exhibited Crush syndrome and Acute Kidney Injury, with only 2 requiring dialysis. Twelve patients required intensive care, and 6 patients succumbed to their injuries.Reference Çağıran, Sertöz and Karaman³

In December 2003, an earthquake with a magnitude of 6.6 struck the Bam region of Iran, resulting in the destruction of over 90% of the city. A study involving 854 victims transported to 12 tertiary care hospitals reported an average age of 29 years. The most common type of injury was lower extremity trauma. Surgical procedures were performed under general anesthesia in 24.1% of cases. Thirty-eight patients were transferred to ICUs, and 28.9% of these ICU patients succumbed to their injuries.Reference Mohebbi, Mehrvarz and Saghafinia⁴

Following 2 catastrophic earthquakes that occurred in relatively close succession, which is rare in history, we conducted a study on the patients admitted to the 30 operating rooms within 1 tower of our tertiary care hospital located in a distant region. A total of 231 patients underwent multiple surgeries, resulting in 650 procedures. The oldest patient was 88 years old. Ten percent of the patients underwent surgery within the first week. The last case was admitted to the operating room 63 days after the initial earthquake. It was found that there were 577 instances of general anesthesia, 56 instances of spinal anesthesia, and administration of 17 other regional block techniques. Trauma patients requiring debridement constituted 74.02% of the cases. Among the trauma patients, the most frequently injured area was the right lower extremity, accounting for 57.57% of the injuries. Thirty-two patients underwent surgery with a preliminary diagnosis of Crush syndrome, of whom 18 (56.25%) required dialysis. Thirty-five (83.3%) patients required mechanical ventilation in the postoperative period. Despite interventions, 9 out of the 231 patients (3.89%) admitted to the operating room could not be saved.

In an assessment of patients admitted to the university hospital in a neighboring city following the 2011 Van earthquake, 169 patients were evaluated. Patients with only orthopedic injuries were categorized as Group I (41 patients), while those with internal medical problems were designated as Group II (128 patients). Among Group I patients, 19.5% had lower extremity injuries. The need for intensive care was higher in Group I. In Group I, 16 patients were diagnosed with crush injuries, whereas no crush injuries were identified in Group II. Additionally, none of the Group I patients developed chronic renal failure. The length of the hospital stay was 10.85±9.85 days in Group 1 and 8.68±12.71 days in Group 2. The leading cause of death in Group 1 was multisystemic trauma (10 patients [70%]) and internal problems in Group 2.Reference Zengin, Icer and Gunduz⁵

Following the Kahramanmaraş earthquakes, a study comprising 375 cases from another major hospital in our city identified the third day after the earthquake as having the highest number of surgical interventions. Among the 323 patients with extremity injuries, 61.6% had lower extremity injuries, 17.1% had upper extremity injuries, and 7.5% had injuries involving both extremities. Similar to our report, general anesthesia was preferred in 93.9% of the cases, while various peripheral nerve blocks were applied in 8.8% of the cases. Renal replacement therapy was administered to 28% of the patients, and there were no intraoperative deaths.Reference Kılınçarslan, Caparlar and Çakırca⁶

This study had some limitations. The data were collected retrospectively from hospital records (including names, surnames, and protocol numbers) and through the hospital’s computer system. Therefore, there was no opportunity to directly interview patients to obtain information. Additionally, Ankara Bilkent City Hospital is an extensive facility consisting of 6 large towers and 6 different operating rooms. The numbers we obtained are from just 1 operating room.

Despite its limitations, we believe the results of this epidemiological study, which evaluated 231 patients who entered the operating room of a large, remote hospital after the earthquake, can contribute to public health organization and planning for future potential disasters. The inclusion of results from a country like ours, with many earthquake regions, in disaster-related education and practices is valuable for the literature. Additionally, we want to emphasize that as much as medical interventions in the field are crucial for disaster preparedness, tertiary health care service providers must be equally well prepared.