[Intensive medicine criteria for operability].
BACKGROUND
Operability is mainly determined by the interaction between the magnitude of an operation and the patient's tolerance for the procedure. A further factor is the benefit gained by performing the procedure versus the sequelae caused by its omission.


RESULTS
Major operations within the first 3 days after trauma appear to have an increased risk, particularly if they are performed during impaired respiratory function (pO(2)/F(i)O(2) ratio <280 mmHg) or increased inflammatory status. Such interventions are recommended to be postponed until a later time. Surgical interventions after day 3 require an individual decision with respect to the timing of the operation. Criteria that are of value in this decision comprise a pO(2)/F(i)O(2) ratio above 280 mmHg, a stable circulation, a platelet count above 100.000 to 150.000/microl, normal global coagulation tests, only moderate systemic inflammation as indicated by C-reactive protein or interleukin-6 levels, a normal fluid balance and in case of traumatic brain injury there should be no signs of increased intracranial pressure. Whether liver function, level of PEEP, catecholamine therapy and other factors will influence operability remains to be elucidated.


CONCLUSIONS
The pathophysiological consequences of accidental trauma show a phasic course with respect to the immunomodulatory response. An operative trauma inflicted by a secondary surgical intervention contributes an additional burden. Depending on the inflammatory phase during which this secondary hit is inflicted there may be a disturbance of homoeostasis that may even lead to multiple organ failure. Whether this happens can depend on type and magnitude of the surgical intervention. Minor operations result in smaller systemic effects and will be less critical with respect to operability.
Waydhas
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Klinik für Unfallchirurgie, Universitätsklinikum, Essen. christian.waydhas@uni-essen.de
Flohe
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D002986:Clinical Trials as Topic; D003422:Critical Care / Q000379:methods* / Q000639:trends; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D009102:Multiple Organ Failure / Q000517:prevention & control* / Q000601:surgery; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D018746:Systemic Inflammatory Response Syndrome / Q000517:prevention & control*; D016896:Treatment Outcome