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Modifiability of surgical timing in postinjury multiple organ failure patients.
- Source :
-
World journal of surgery [World J Surg] 2024 Feb; Vol. 48 (2), pp. 350-360. Date of Electronic Publication: 2024 Jan 12. - Publication Year :
- 2024
-
Abstract
- Background: Postinjury multiple organ failure (MOF) is the leading cause of late trauma deaths, with primarily non-modifiable risk factors. Timing of surgery as a potentially modifiable risk factor is frequently proposed, but has not been quantified. We aimed to compare mortality, hospital length of stay (LOS), and ICU LOS between MOF patients who had surgery that preceded MOF with modifiable timings versus those with non-modifiable timings.<br />Methods: Retrospective analysis of an ongoing 17-year prospective cohort study of ICU polytrauma patients at-risk of MOF. Among MOF patients (Denver score>3), we identified patients who had surgery that preceded MOF, determined whether the timing of these operation(s) were modifiable(M) or non-modifiable (non-M), and evaluated the change in physiological parameters as a result of surgery.<br />Results: Of 716 polytrauma patients at-risk of MOF, 205/716 (29%) developed MOF, and 161/205 (79%) had surgery during their ICU admission. Of the surgical MOF patients, 147/161 (91%) had one or more operation(s) that preceded MOF, and 65/161 (40%) of them had operation(s) with modifiable timings. There were no differences in age (mean (SD) 52 (19) vs 53 (21)years), injury severity score (median (IQR) 34 (26-41)vs34 (25-44)), admission physiological and resuscitation parameters, between M and non-M-patients. M patients had longer ICU LOS (median (IQR) 18 (12-28)versus 11 (8-16)days, p < 0.0001) than non-M-patients, without difference in mortality (14%vs16%, p = 0.7347), or hospital LOS (median (IQR) 32 (18-52)vs27 (17-47)days, p = 0.3418). M-patients had less fluids and transfusions intraoperatively. Surgery did not compromise patient physiology.<br />Conclusion: Operations preceding MOF are common in polytrauma and seem to be safe in maintaining physiology. The margin for improvement from optimizing surgical timing is modest, contrary to historical assumptions.<br /> (© 2024 The Authors. World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)
- Subjects :
- Humans
Female
Male
Middle Aged
Retrospective Studies
Adult
Time Factors
Intensive Care Units statistics & numerical data
Risk Factors
Hospital Mortality
Prospective Studies
Aged
Multiple Organ Failure mortality
Multiple Organ Failure etiology
Length of Stay statistics & numerical data
Multiple Trauma surgery
Multiple Trauma mortality
Multiple Trauma complications
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2323
- Volume :
- 48
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- World journal of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 38686758
- Full Text :
- https://doi.org/10.1002/wjs.12076