Predicting multiple organ failure after major orthopedic interventions is possible using only conventional laboratory...

The decision to delay secondary, non-life-saving orthopedic surgery to reduce the risk of multiple organ failure (MOF) or sepsis is largely based on expert opinion. A decision-making tool may solve this problem by pre-operatively reflecting the patient's inflammatory/coagulation status. We aimed to determine whether the combination of readily available measures of inflammation and coagulation could predict MOF/sepsis in polytrauma patients.

We conducted a prospective single-center study of adult trauma patients requiring pelvic/acetabular surgery. Patients were recruited from October 2011-January 2018. The primary outcome was postoperative MOF and sepsis. Full blood count, prothrombin time, activated partial thromboplastin time, international normalized ratio, fibrinogen, complement C3 and C4, C-reactive protein, tryptase, cortisol, and interleukin-6 were collected preoperatively and 30 min, 1 day, and 3 days postoperatively. Principal component analysis (PCA) was used to cluster the data within and across time. Logistic regression was used to predict MOF or sepsis using the top 4 principal components.

A total of 157 patients were recruited. The incidence of MOF and sepsis was 7% and 13%, respectively. PCA of preoperatively-collected immune and coagulation markers predicted MOF (area under the curve [AUC]: 0.94). Using routine tests alone predicted MOF with an AUC of 0.94. Sepsis was predictable with less accuracy than MOF from PCA (preoperative-AUC: 0.76).

The routine clinical data available prior to non-life-saving definitive pelvic/acetabular surgery could predict MOF, and may serve as a tool for orthopedic surgeons to optimise the timing of surgery. Multi-centre, prospective investigation is required for validation.