Optimal timing for secondary surgery in polytrauma patients: an evaluationof 4314 serious-injury cases

Introduction: It has been argued that secondary operations in multiple trau ma patients impose an additional systemic burden, representing an additiona l risk of organ dysfunction. We investigated whether the timing of a second ary operation of > 3 h duration is related with the development of organ dy sfunction. Methods: In a retrospective analysis, 4314 polytrauma patients t reated at our institution between January 1975 and January 1999 were invest igated. Patients were divided according to the presence (+ MOF) or absence (-MOF) of organ failure (Goris' criteria). Results: In both groups, the inj ury severity, rescue time, duration and incidence of primary operations wer e comparable. Secondary surgery in patients who later developed organ failu re was significantly more often performed between day 2 and 4, whereas pati ents without organ failure were usually operated between day 6 and 8 (P < 0 .0001). The initial laboratory data in these two groups were comparable. If patients with organ failure were operated on days 6-8, significantly worse initial laboratory data were determined, indicating that these patients we re at high risk of developing MOF. Conclusion: In patients with severe trau ma requiring secondary operations of > 3 h duration, performance of this op eration should be avoided on post trauma days 2-4.