[Comparing Outcomes of Primary vs. Secondary Admission to a Level 1 Trauma Centre in the Management of...

The management of open fractures with extensive soft tissue defects presents a significant challenge to healthcare systems. A key factor for a successful and efficient treatment is the early implementation of an interdisciplinary approach involving both trauma and plastic surgery - commonly referred to as the "orthoplastic approach". This systematic review aims to compare treatment outcomes between patients who were either directly transferred (primary transfer) from the scene of injury to a level 1 trauma centre and those who initially received care at a lower-level hospital and were subsequently transferred (secondary transfer) to a level 1 trauma centre.This systematic review was conducted in accordance with the PRISMA guidelines. A comprehensive literature search was performed in the MEDLINE database. Fourteen studies were included in the final analysis. Patients were categorized into a primary transfer group (PRI) or a secondary transfer group (SEK) for the analysis. Outcomes assessed included transfer time, length of hospital stay, time to initial surgical intervention, timing of definitive bony fixation and soft tissue reconstruction, total number of surgical procedures, reconstruction techniques and their associated complications, as well as rates of non-union and infection.A total of 14 studies comprising 5294 patients were included. Of the reported fractures, 88.6% were classified as Gustilo-Anderson type IIIB or higher. The median length of hospital stay was shorter in the primary transfer group (26.6 days) compared to the secondary transfer group (35.2 days). In the secondary group, delays were observed in time to initial surgical intervention, definitive bony fixation, and final soft tissue reconstruction. The median number of surgical procedures and osteomyelitis was lower in the primary transfer group.Delayed secondary transfer to a level 1 trauma centre may be associated with relevant disadvantages for patients. In addition to timing, early formulation of a reconstructive treatment plan by an interdisciplinary and specialized team is a decisive factor. This may reduce the total number of required interventions and improve functional outcomes. The goal should be the primary implementation of the orthoplastic treatment approach, for which specialized trauma centres offer the best conditions.