The severely injured trauma patient – most common surgical life-saving procedures and impact of hemodynamic instability on treatment process

Abstract

Abstract Background There are few data on the most common life-threatening injuries and the corresponding surgical procedures required in trauma patients in German level 1 trauma centres. It is also unclear whether and to what extent hemodynamic instability affects the treatment process in terms of time to surgery, operative time and usage of damage control protocols. Methods A retrospective evaluation of all patients with an ISS > 16 admitted to a single level-1 trauma unit between 01/2017 and 09/2022 and subsequentsurgery with vital indication was performed. Patients with systolic blood pressure > 80 mmHg on arrival were defined as hemodynamicallystable (group 1) and were compared to patients with systolic blood pressure < 80 mmHg (hemodynamically unstable; group 2). A descriptive analysis was performed, and Fisher’s exact testand the Mann‒Whitney U test were used to calculate differences between groups where appropriate. Results Sixty patients were included in our study. Of these, 26 (43%) were referred to as hemodynamically unstable, and 34 (57%) were stable. Abdominal bleeding from the spleen (30%), liver (21%) and mesentery (21%) were the most common life-threatening injuries, followed by hemothorax (13%). As a consequence, abdominal surgeons performed life-saving surgical procedures most often (65% vs. vascular surgeons = 18% vs. thoracic surgeons = 14% vs. orthopaedic surgeons = 3%). Between groups 1 and 2, significant differences could be evaluated for time to surgery (107 vs. 70 min.; p < 0.001), ISS (22 vs. 34 points; p < 0.001), duration of surgery (147 vs. 107 min.; p = 0.016), and usage of damage control surgery protocols (53 vs. 88%; p = 0.005). Conclusion Our data from a German level 1 trauma centre show that 1) life-threatening injuries in polytrauma patients are most commonlylocated in the abdomen, 2) abdominal surgeons perform life-saving surgical procedures (e.g., bleeding control) most often, 3) haemodynamic instability on arrival reduces time to surgery and operative time, and 4) increases the usage of damage control protocol significantly.