Klingebiel, Felix Karl-Ludwig; https://orcid.org/0000-0002-6438-5208, Hasegawa, Morgan, Strähle, Oliver, Kalbas, Yannik; https://orcid.org/0000-0002-1550-328X, Teuben, Michel; https://orcid.org/0000-0003-0310-4668, Halvachizadeh, Sascha; https://orcid.org/0000-0003-1393-3232, Kumabe, Yohei; https://orcid.org/0000-0003-2356-2930, Pape, Hans-Christoph; https://orcid.org/0000-0002-2059-4980, Pfeifer, Roman; https://orcid.org/0000-0003-1543-3995, SICOT Trauma Research Group, Klingebiel, Felix Karl-Ludwig; https://orcid.org/0000-0002-6438-5208, Hasegawa, Morgan, Strähle, Oliver, Kalbas, Yannik; https://orcid.org/0000-0002-1550-328X, Teuben, Michel; https://orcid.org/0000-0003-0310-4668, Halvachizadeh, Sascha; https://orcid.org/0000-0003-1393-3232, Kumabe, Yohei; https://orcid.org/0000-0003-2356-2930, Pape, Hans-Christoph; https://orcid.org/0000-0002-2059-4980, Pfeifer, Roman; https://orcid.org/0000-0003-1543-3995, and SICOT Trauma Research Group
PURPOSE It is known that the magnitude of surgery and timing of surgical procedures represents a crucial step of care in polytraumatized patients. In contrast, it is not clear which specific factors are most critical when evaluating the surgical load (physiologic burden to the patient incurred by surgical procedures). Additionally, there is a dearth of evidence for which body region and surgical procedures are associated with high surgical burden. The aim of this study was to identify key factors and quantify the surgical load for different types of fracture fixation in multiple anatomic regions. METHODS A standardized questionnaire was developed by experts from Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT)-Trauma committee. Questions included relevance and composition of the surgical load, operational staging criteria, and stratification of operation procedures in different anatomic regions. Quantitative values according to a five-point Likert scale were chosen by the correspondents to determine the surgical load value based on their expertise. The surgical load for different surgical procedures in different body regions could be chosen in a range between "1," defined as the surgical load equivalent to external (monolateral) fixator application, and "5," defined as the maximal surgical load possible in that specific anatomic region. RESULTS This questionnaire was completed online by 196 trauma surgeons from 61 countries in between Jun 26, 2022, and July 16, 2022 that are members of SICOT. The surgical load (SL) overall was considered very important by 77.0% of correspondents and important by 20.9% correspondents. Intraoperative blood loss (43.2%) and soft tissue damage (29.6%) were chosen as the most significant factors by participating surgeons. The decision for staged procedures was dictated by involved body region (56.1%), followed by bleeding risk (18.9%) and fracture complexity (9.2%). Percutaneous or intramedullary procedures as