Direct traumatic injuries and operative stress associated with each surgery should be considered as aggression in the conditions of multiple trauma. Pronounced stress response due to major surgery can deplete the already weakened metabolic reserves of the body. The purpose of the study was to evaluate operative stress as part of many stages of operational correction for the Damage Control on the background of pre-existing traumatic disease as a predictor of hospital complications in patients with polytrauma. Material and methods. 224 patients with multiple traumas, ISS >15 points, class III-IV blood loss according to the classification of the American College of Surgeons, temperature core body 34-36 o C, age 18 to 60 years, absence of severe traumatic brain injury were studied. Patients were different in terms of time and volume of surgery and were divided into 2 groups according these criteria. The first group included 104 patients, who underwent surgery in full within the first 24 hours after admission. The second group included 120 patients. They needed one or more additional operations. All their injuries were repaired using multi-stage surgical correction. Results and discussion. On admission to the hospital, all of patients, regardless of the specific set of injuries, did not differ significantly in the severity of injuries, physiological deteriorations (p >0,05). In this case, patients were considered severely unstable (according to the ISS, RTS, Military field surgery scales), with a predicted maximum mortality rate of 33% (according to the Military field surgery and TRISS, PTS, APACHE II scales) for both groups and level of expected complications 34% (Military field surgery). The level of complications was significantly higher in the second group than in the first group. Post-traumatic nephropathy was diagnosed in 25 patients (24%) of the first group and 46 patients (38%) of second group. Infectious complications were found in group I in 31% of cases, group II had 51% of cases. In the first group, the total number of thrombohemorrhagic complications was 16%, in the second group it was 29%. Conclusion. In patients of the second group who underwent a number of additional surgical interventions according to the tactics of multi-stage surgical correction, the level of complications was more than 1.5 times higher than the first group (р˂0,05). Therefore, every subsequent surgery destroys the conventional notion of a classic traumatic disease course.
Keywords: multi-stage surgical correction, complications, polytrauma
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