Timing of planned reoperation after damage control surgery in patients with trauma: a systematic review and...

Damage control surgery (DCS) is the standard approach for managing severely injured patients with trauma who present with extreme physiological derangements. The optimal timing for planned reoperation after the initial DCS remains contentious. Although traditional guidelines recommend reoperation within 24-48 h, emerging evidence suggests this interval may not be appropriate for all patients. This systematic review and meta-analysis evaluated the impact of early versus delayed planned reoperations on the clinical outcomes in patients with trauma following DCS.

This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (PROSPERO registration: CRD420251049990). PubMed, Embase, and the Cochrane Library were searched from inception to 28 July 2025. Eligible studies compared early (≤ 48 h) with delayed (> 48 h) planned reoperation after DCS in adult patients with trauma. The primary outcome was re-bleeding; secondary outcomes were in-hospital mortality and infection rates. Study quality was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was graded using the GRADE approach. Meta-analysis was conducted using random-effects models.

Seven retrospective cohort studies involving 965 patients met the inclusion criteria. No prospective or randomised controlled trials were identified. Early planned reoperation was associated with significantly higher re-bleeding rates (OR 3.01; 95% CI 1.21-7.51; P = 0.02), indicating three-fold higher odds of re-bleeding with early intervention compared to delayed reoperation. No significant differences were observed in mortality (OR 0.79; 95% CI 0.51-1.23; P = 0.29; I² = 0%) or infection rates (OR 1.05; 95% CI 0.54-2.05; P = 0.89; I² = 65%).

Delayed planned reoperation beyond 48 h after DCS significantly reduces the risk of re-bleeding, without increasing mortality or infection rates. These findings support an individualised approach to reoperation timing guided by patient physiology, rather than rigid adherence to conventional 24- to 48-h protocols.