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[Optimal timing for secondary surgery in polytrauma patients: an evaluation of 4,314 serious-injury cases]
H Pape1, M Stalp, M v Griensven
1Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Introduction:
It has been argued that secondary operations in multiple trauma patients impose an additional systemic burden, representing an additional risk of organ dysfunction. We investigated whether the timing of a secondary operation of > 3 h duration is related with the development of organ dysfunction.
Methods:
In a retrospective analysis, 4,314 polytrauma patients treated at our institution between January 1975 and January 1999 were investigated. Patients were divided according to the presence ( + MOF) or absence (-MOF) of organ failure (Goris' criteria).
Results:
In both groups, the injury severity, rescue time, duration and incidence of primary operations were comparable. Secondary surgery in patients who later developed organ failure was significantly more often performed between day 2 and 4, whereas patients without organ failure were usually operated between day 6 and 8 (P < 0.0001). The initial laboratory data in these two groups were comparable. If patients with organ failure were operated on days 6-8, significantly worse initial laboratory data were determined, indicating that these patients were at high risk of developing MOF.
Conclusion:
In patients with severe trauma requiring secondary operations of > 3 h duration, performance of this operation should be avoided on post trauma days 2-4.
