Timing and duration of the initial pelvic stabilization after multiple trauma in patients from the German trauma registry: is there an influence on outcome?
BACKGROUND
There is an ongoing debate about the systemic burden of early definitive fracture stabilization in multiply injured patients. In patients with extremity fractures, the benefit of limited initial surgery has been examined. In this retrospective analysis, we assessed whether differences in outcome can be attributed to the degree of initial surgery in polytrauma patients with pelvic-ring fractures.


METHODS
Multiply injured patients of the German Trauma Registry (Injury Severity Score [ISS] > or =16) with pelvic-ring fractures in need of surgery were analyzed for independent effects of the duration and the timing of the initial surgical stabilization of the pelvis. We compared three subgroups according to duration (D) [short (S): <1 hour; intermediate (I): 1-3 hours; and long (L): >3 hours] and timing (T) [early (E): day 0; intermediate (I): days 1-3; and late (L): day >3]. In addition, a subgroup analysis dependent on injury severity was performed. Statistics included analysis of variance, post-hoc Tukey test, chi test, Student's t test, with significance at p < 0.05.


RESULTS
Demographic data and injury severity were comparable between the groups. The duration of surgery was associated with a higher rate of liver failure (group D-S: 6%; D-I: 17%; D-L: 28%; p = 0.028). The timing of surgery was associated with a higher rate of renal failure (T-E: 17%; T-I: 3%; T-L: 5%; p = 0.021), multiorgan failure (T-E: 27%; T-I: 23%; T-L: 13%; p = 0.024) and mortality (T-E: 18%; T-I: 19%; T-L: 4%; p = 0.019). There was improved mortality, lower rates of multiorgan failure, and sepsis in patients with higher ISS for procedures less than 3 hours.


CONCLUSIONS
In our retrospective analysis, both initial short as well as delayed surgery were associated with a lower rate of organ failure and mortality in multiply injured patients (ISS > or =16). This is especially supported for patients with high ISS.
Probst
Christian
C
Department of Trauma Surgery,Hannover Medical School, Hannover, Germany. probst.christian@MH-hannover.de
Probst
Tarane
T
Gaensslen
Axel
A
Krettek
Christian
C
Pape
Hans Christoph
HC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D050723:Fractures, Bone / Q000401:mortality / Q000601:surgery*; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery*; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome