Prolonged Surgery Should Be Avoided in Certain Trauma Cases

Trauma patients who have several orthopedic injuries and are considered to be in unstable condition should only have a few hours of surgery when first arriving at the hospital, according to a new review of studies.

Researchers from the University of Aachen (Germany) analyzed data from several trauma registries in Germany, and compared patient outcomes in 21,000 trauma patients with the amount of hours each patient had spent in the operating room (OR). According to the researchers, the data show that too many surgeries and blood loss can weaken the immune system, and can lead to a higher likelihood of experiencing complications after surgery. The major benefit of scheduling surgery to repair fractures over the span of several days, the authors claimed, is that it allows the trauma patient to recover from each surgical procedure before moving forward with the next one. It is important to monitor blood pressure, pulmonary function, and immune function to see if patients are stable enough to undergo further surgery.

The researchers suggest it often is best to use an external fixator to stabilize an orthopedic injury to stop the initial pain and bleeding; the data suggest that subsequently waiting for two or three days until the patient is stable presents a more ideal time to begin other more invasive and time-consuming operations. The benefits of initially limiting time in the operating room for patients with life-threatening injuries, known colloquially as "damage control,” include less blood loss during surgery, fewer complications in the intensive care unit (ICU), less stimulation of the immune system, and higher patient survival rates. The study was published in the September 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

"We found that patients with life-threatening injuries, such as chest contusions or liver lacerations in association to multiple bone fractures, and who have surgery for six or more hours do not always do as well,” said lead author Hans-Christoph Pape, M.D., chairman of orthopedic and trauma surgery department. "If you limit the amount of time in the operating room to less than three hours, patients appear to do better. Timing is key in patients with life-threatening injuries. There needs to be close communication between the orthopedic surgeon, the general surgeon, and ICU staff. All members of the care team need to reevaluate the patient throughout the process to see if it is safe to fix the next fracture.”

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