Definitive surgery is safe in borderline patients that respond to resuscitation.

OBJECTIVES We hypothesize that in adequately resuscitated borderline polytrauma patients with long bone fractures (femur and tibia) or pelvic fractures; early (within 4 days) definitive stabilization (EDS) can be performed without an increase in post-operative ventilation and post-operative complications. DESIGN Retrospective Cohort Study SETTING:: Level 1 Trauma Centre PATIENTS:: In total 103 patients were included in this study of which 18 (17.5%) were female and 85(82.5%) were male. These patients were borderline trauma patients who had the following parameters prior to definitive surgery, normal coagulation profile, lactate 4 days). MAIN OUTCOME MEASUREMENTS Primary outcome measured was duration of ventilation more than 3 days post definitive surgery and presence of post-operative complications. RESULTS 35 (34.0%) patients received ETC, while 68 (66.0%) patients were treated with DCO. In total 51 (49.5%) of all patients had LDS while 52 (50.5%) patients had EDS. On Logistic Regression the following factors were found to be predictive of higher rates of post -operative ventilation ≥ 3 days, Units of Blood Transfused and time to definitive surgery>4 days. Increased age, Head AIS 3 or more and Time to definitive surgery were found to be associated with an increased risk of post-operative complications. CONCLUSIONS Borderline polytrauma patients with no severe soft tissue injuries such as chest or head injuries may be treated with EDS if adequately resuscitated with no increase in need for post-operative ventilation and complications. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.