Timing of Surgical Fixation in Polytrauma Patients with Long Bone Fractures

Abstract

Background: Early versus late surgery has been a topic of considerable debate, particularly regarding its impact on postoperative outcomes. Delaying surgery may lead to complications such as pneumonia, thromboembolic events, and other adverse effects, potentially influencing patient recovery and mortality rates. On the other hand, early surgical intervention may offer benefits by reducing the possibility of such complications and improving overall recovery.

Aim: This meta-analysis study aimed to assess the influence of early (less than twenty-four hours) vs. delayed (>24 hours) surgical fixation of long bone fractures on outcomes like mortality, ARDS, and infection rates in polytrauma patients.

Methods: A search of PubMed, Embase, Cochrane Library, and Google Scholar identified studies with keywords as follows: early surgery, late surgery, postoperative pneumonia, thromboembolic events, complications, and mortality. Additional searches were done on ClinicalTrials.gov, and relevant references were reviewed.

Results: This meta-analysis, including 14 studies with 18,189 patients, was included in the analysis. Analysis of postoperative pneumonia revealed a statistically significant variance between early and late surgery groups (mean difference 0.51, ninety-five percent CI 0.39 to 0.67, Z = 4.94, P-value less than 0.0001). Nevertheless, insignificant
variance was detected in postoperative thromboembolic events (mean difference 0.47, 95% CI 0.20 to 1.10, Z = 1.74, P = 0.08). Statistically significant variances have been found in complications (mean difference 0.56, 95% CI 0.43 to 0.71, Z = 4.70, P-value less than 0.001), but insignificant variances were detected in mortality at 24 hours (mean difference 0.82, 95% CI 0.68 to 1.01, Z = 1.90, P = 0.06) or 48 hours (mean difference 4.56, ninety-five percent CI 0.05 to 400.83, Z = 0.66, P = 0.51).

Conclusion: Early surgery has been related a significantly reduced frequency of postoperative pneumonia and complications, while insignificant variances have been detected in thromboembolic events or mortality at 24 or 48 hours. These findings suggest that early surgery may offer better outcomes in terms of postoperative pneumonia and complications