Bruno C Coimbra, Junsik Kwon, Bishoy Zakhary, Babak Sarani, Matthew Firek, Timothy Allison-Aipa, Raul Coimbra
{"title":"与早期全面护理相比，损伤控制不能提供生存优势，而且增加了严重并发症的风险。","authors":"Bruno C Coimbra, Junsik Kwon, Bishoy Zakhary, Babak Sarani, Matthew Firek, Timothy Allison-Aipa, Raul Coimbra","doi":"10.1097/TA.0000000000004594","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Damage control orthopedics (DCO) was proposed to minimize the second hit of extensive surgical procedures in severely injured patients when treated with early fracture fixation (early total care [ETC]). The impact of DCO and ETC on the outcomes of severely injured patients sustaining femoral shaft fractures (FSFs) is unclear. We hypothesized that DCO is associated with lower mortality and decreased incidence of complications compared with ETC.</p><p><strong>Methods: </strong>The Trauma Quality Improvement Project database was queried from 2007 to 2021. Adult patients 14 years or older with FSF and Injury Severity Score of >15 were included. Patients were divided into ETC and DCO groups and stratified according to fracture type: open or closed. The primary outcomes included acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), severe sepsis, deep venous thrombosis (DVT), and mortality. Inverse probability treatment of weighting was used to balance the two cohorts of interest. A binomial logistic regression analysis was performed after inverse probability treatment of weighting to identify potential associations between the type of fixation procedure and the outcomes of interest.</p><p><strong>Results: </strong>A total of 44,577 FSF patients were included. Mortality was 2.1%. No survival advantage was observed in the DCO group (odds ratio [OR], 0.92). However, significant associations between DCO and the risk of ARDS (OR, 1.64), AKI (OR, 1.57), severe sepsis (OR, 1.64), and DVT (OR, 1.64) were identified. Damage control orthopedics was not associated with decreased mortality after stratifying patients according to the fracture type and the type of operation.</p><p><strong>Conclusion: </strong>Damage control orthopedics is not associated with improved survival of severely injured patients with FSF. Damage control orthopedics is associated with an increased risk of ARDS, AKI, severe sepsis, and DVT compared with ETC. These findings persisted after analyzing the type of fracture. These results are significant for clinical practice, as more patients could be treated by ETC when compensated physiologically, independent of the fracture type.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"907-914"},"PeriodicalIF":2.9000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Damage control does not offer a survival advantage and increases the risk of serious complications compared with early total care in severely injured patients with femoral shaft fractures.\",\"authors\":\"Bruno C Coimbra, Junsik Kwon, Bishoy Zakhary, Babak Sarani, Matthew Firek, Timothy Allison-Aipa, Raul Coimbra\",\"doi\":\"10.1097/TA.0000000000004594\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Damage control orthopedics (DCO) was proposed to minimize the second hit of extensive surgical procedures in severely injured patients when treated with early fracture fixation (early total care [ETC]). The impact of DCO and ETC on the outcomes of severely injured patients sustaining femoral shaft fractures (FSFs) is unclear. We hypothesized that DCO is associated with lower mortality and decreased incidence of complications compared with ETC.</p><p><strong>Methods: </strong>The Trauma Quality Improvement Project database was queried from 2007 to 2021. Adult patients 14 years or older with FSF and Injury Severity Score of >15 were included. Patients were divided into ETC and DCO groups and stratified according to fracture type: open or closed. The primary outcomes included acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), severe sepsis, deep venous thrombosis (DVT), and mortality. Inverse probability treatment of weighting was used to balance the two cohorts of interest. A binomial logistic regression analysis was performed after inverse probability treatment of weighting to identify potential associations between the type of fixation procedure and the outcomes of interest.</p><p><strong>Results: </strong>A total of 44,577 FSF patients were included. Mortality was 2.1%. No survival advantage was observed in the DCO group (odds ratio [OR], 0.92). However, significant associations between DCO and the risk of ARDS (OR, 1.64), AKI (OR, 1.57), severe sepsis (OR, 1.64), and DVT (OR, 1.64) were identified. Damage control orthopedics was not associated with decreased mortality after stratifying patients according to the fracture type and the type of operation.</p><p><strong>Conclusion: </strong>Damage control orthopedics is not associated with improved survival of severely injured patients with FSF. Damage control orthopedics is associated with an increased risk of ARDS, AKI, severe sepsis, and DVT compared with ETC. These findings persisted after analyzing the type of fracture. These results are significant for clinical practice, as more patients could be treated by ETC when compensated physiologically, independent of the fracture type.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level IV.</p>\",\"PeriodicalId\":17453,\"journal\":{\"name\":\"Journal of Trauma and Acute Care Surgery\",\"volume\":\" \",\"pages\":\"907-914\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Trauma and Acute Care Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/TA.0000000000004594\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/20 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Trauma and Acute Care Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/TA.0000000000004594","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/20 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Damage control does not offer a survival advantage and increases the risk of serious complications compared with early total care in severely injured patients with femoral shaft fractures.
Background: Damage control orthopedics (DCO) was proposed to minimize the second hit of extensive surgical procedures in severely injured patients when treated with early fracture fixation (early total care [ETC]). The impact of DCO and ETC on the outcomes of severely injured patients sustaining femoral shaft fractures (FSFs) is unclear. We hypothesized that DCO is associated with lower mortality and decreased incidence of complications compared with ETC.
Methods: The Trauma Quality Improvement Project database was queried from 2007 to 2021. Adult patients 14 years or older with FSF and Injury Severity Score of >15 were included. Patients were divided into ETC and DCO groups and stratified according to fracture type: open or closed. The primary outcomes included acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), severe sepsis, deep venous thrombosis (DVT), and mortality. Inverse probability treatment of weighting was used to balance the two cohorts of interest. A binomial logistic regression analysis was performed after inverse probability treatment of weighting to identify potential associations between the type of fixation procedure and the outcomes of interest.
Results: A total of 44,577 FSF patients were included. Mortality was 2.1%. No survival advantage was observed in the DCO group (odds ratio [OR], 0.92). However, significant associations between DCO and the risk of ARDS (OR, 1.64), AKI (OR, 1.57), severe sepsis (OR, 1.64), and DVT (OR, 1.64) were identified. Damage control orthopedics was not associated with decreased mortality after stratifying patients according to the fracture type and the type of operation.
Conclusion: Damage control orthopedics is not associated with improved survival of severely injured patients with FSF. Damage control orthopedics is associated with an increased risk of ARDS, AKI, severe sepsis, and DVT compared with ETC. These findings persisted after analyzing the type of fracture. These results are significant for clinical practice, as more patients could be treated by ETC when compensated physiologically, independent of the fracture type.
Level of evidence: Therapeutic/Care Management; Level IV.
期刊介绍：
The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
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