[Operation planning of secondary interventions after polytrauma].
A prospective study of 135 secondary operations (> 24 h after trauma) in patients with multiple injuries (ISS 40.6 pts) was performed to determine specific and unspecific indicators of the inflammatory response that may indicate the degree of risk of postoperative organ failure in these patients. On the morning of the operation each patients' data were recorded and blood samples were collected. Patients were divided in those in whom respiratory, renal and/or hepatic failure developed or preexisting organ failure worsened by more than 20% from baseline within 2 days after the operation and those who had no complications. In 29 patients who were operated upon between 24 and 72 h after trauma only the pO2/FiO2 ratio allowed discrimination between the two groups. The overall accuracy of this parameter as a predictor of postoperative organ failure was 83%, with a sensitivity of 78% and a specificity of 85%. In 106 patients with secondary operations later than 72 h after trauma, neutrophil elastase, C-reactive protein and platelet count revealed the highest predictive accuracy, with cut-off values of 250 ng/ml, 11 mg/dl and 180 x 10(6)/ml, respectively. The combined accuracy of these three parameters in prediction of postoperative organ failure was 79% (sensitivity 73%, specificity 83%). In this group of patients the pO2/FiO2 ratio was of less value and blood pressure, heart rate, renal function parameters, lactate and coagulation parameters were of no value.(ABSTRACT TRUNCATED AT 250 WORDS)
Waydhas
C
C
Chirurgische Klinik und Poliklinik, Klinikum Innenstadt, Universität München.
Nast-Kolb
D
D
Kick
M
M
Zettl
R
R
Wiesholler
J
J
Trupka
A
A
Jochum
M
M
Schweiberer
L
L
D000210:Acute-Phase Reaction / Q000401:mortality / Q000601:surgery; D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality / Q000601:surgery; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery*; D010347:Patient Care Planning; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors
Operationsplanung von sekundären Eingriffen nach Polytrauma.