Timing of definitive surgery in multiply injured patients remains a topic of debate.
The purpose of this study was to test whether the mortality rate depends on the
surgical treatment strategy and if multiple parameters are able to predict the best
strategy applied.
Retrospective cohort study, multiply injured patients primarily admitted at a Level I
trauma center, with an injury severity score (ISS) ≥ 16 points and requirement for
surgical intervention. Exclusion criteria: incomplete data set. Primary outcome: Inhospital
mortality rate. Secondary outcome: Influence of injury distribution and patient"s
condition on admission on treatment strategy and predictive parameters. Group
distribution (timing of definitive surgery): Early total care (ETC, <24h), safe definitive
surgery (SDS <48h), damage control (DC, >48h). Univariate and multivariate analyses
of odds ratio (OR) and 95% confidence interval (CI) regarding, mortality and the
prediction of the treatment strategy.
N= 1471 patients between Jan 1, 2016 and Dec 31, 2022, mean age 55.6±20.4 years,
mean ISS 23.1±11.4 points. Patients were stratified to ETC (n=85, 5.8%), SDS (n=665,
45.2%), and DC (n=721, 49.0%). The mortality rate was 22.4% in ETC, 16.1% in SDS,
and 39.7% in DC. Severe abdominal injuries were associated with ETC (OR 2.2,
95%CI 1.4 to 3.5), as were spinal injuries (OR1.6, 95%CI 1.2 to 2.2). Extremity injuries
were associated with SDS (OR1.7, 9%%CI 1.4 to 2.2) and TBI with DC (OR1.3, 95%
CI 1.1 to 1.4). After correction for severity of head, abdominal, spinal, extremity injuries,
and pathophysiologic parameter at admission, mortality was 30% less in SDS when
compared with DC (OR0.3, 95%CI 0.2 to 0.4).
Our study reveals that different surgical strategies are triggered by the injury
distribution, all are associated with acceptable outcomes in regards to mortality.
Multiple parameters determine the selection of patients towards a surgical treatment
strategy accordingly.
No