Optimal duration of primary surgery with regards to a "borderline"-situation in polytrauma patients

Primary stabilization of major fractures in polytrauma patients is known to represent an important principle of treatment and has been shown to reduce the incidence of posttraumatic complications and of organ failure. However , in critically injured patients it has been discussed that extensive prima ry definitive treatment may also cause adverse effects due to its systemic burden by blood loss, loss of temperature etc. Patients who deteriorated un expectedly following primary surgery have been named "borderline patients". In these patients it appears necessary to limit the amount of operative pr ocedures, e. g. by performing temporary fixation of major fractures primari ly. The threshold beyond which surgical procedures may cause more harm than good has not been well defined. This holds true especially for the duratio n of primary surgery. We investigated the clinical outcome in a large numbe r of prospectively documented multiple trauma patients with respect of the duration of primary fracture stabilization. If a primary surgical procedure exceeded 6 hours in multiple trauma patients with an ISS of 25 points, pat ients demonstrated a significantly elevated ventilation time, an increased mortality, and a higher incidence of death from MOF in comparison with pati ents that were injured comparably, but were submitted to shorter primary op erative procedures.