Vetter Philipp, Niggli Cédric, Hambrecht Jan, Pape Hans-Christoph, Mica Ladislav
Department of Trauma Surgery, University Hospital Zurich, 8091 Zurich, Switzerland.
Medicina (Kaunas). 2025 Jan 22;61(2):183. doi: 10.3390/medicina61020183.
In the triaging of polytrauma, patients with less severe injuries and lower somatic stress often undergo isolated definitive orthopedic surgery without damage-control procedures. Adverse events, particularly sepsis, should be minimized. We aimed to identify sex-specific predictors for sepsis in polytrauma patients undergoing stand-alone definitive surgery. Our institutional trauma database, containing data from 3653 patients between 1996 and 2022, was filtered for polytrauma patients who underwent definitive surgery, were aged ≥16 years, and had an Injury Severity Score (ISS) ≥16. Injury and physiological parameters were documented upon admission, as well as on the first and second days thereafter. Surgical data were also recorded. All factors were evaluated for their association with sepsis development. Among the 276 patients (71.1% male; mean age 45.0 years, 95% confidence interval 42.7-47.2 years; median ISS of 27, interquartile range, 20-34), the rate of sepsis was 13.8% (n = 38), with a higher incidence in males (16.7%; n = 33) than in females (6.8%; n = 5) ( = 0.026). Head and thorax injuries were more common and severe in septic males, with thorax injuries being predictive. Male patients who developed sepsis also had a higher ISS, an increased heart rate (HR), and lower pH at admission, with ISS and HR being predictive of sepsis. On the first day post-admission, septic males showed higher Base Excess and lower Prothrombin Time. Lactate levels were elevated on both the first and second days post-admission. Surgical predictors for males included less primary extremity surgeries and later secondary spine surgeries. Sepsis is more common in males undergoing stand-alone definitive surgery. Several factors, particularly acidosis and coagulopathy, are associated with this phenomenon. Fewer primary extremity surgeries and delayed secondary spine surgeries were also linked to a higher sepsis risk in males. These findings may help identify patients eligible for stand-alone definitive surgery and underscore the need for more data on female polytrauma patients.
在多发伤的分诊中，伤势较轻且躯体应激较低的患者通常接受单纯的确定性骨科手术，而无需采取损伤控制措施。应尽量减少不良事件，尤其是脓毒症的发生。我们旨在确定接受单纯确定性手术的多发伤患者发生脓毒症的性别特异性预测因素。我们的机构创伤数据库包含1996年至2022年间3653例患者的数据，从中筛选出接受确定性手术、年龄≥16岁且损伤严重程度评分（ISS）≥16的多发伤患者。入院时以及此后的第一天和第二天记录损伤和生理参数。还记录了手术数据。评估所有因素与脓毒症发生的相关性。在276例患者中（男性占71.1%；平均年龄45.0岁，95%置信区间42.7 - 47.2岁；ISS中位数为27，四分位间距为20 - 34），脓毒症发生率为13.8%（n = 38），男性发生率（16.7%；n = 33）高于女性（6.8%；n = 5）（P = 0.026）。脓毒症男性患者的头部和胸部损伤更常见且更严重，胸部损伤具有预测性。发生脓毒症的男性患者入院时ISS更高、心率（HR）增加且pH值更低，ISS和HR可预测脓毒症。入院后第一天，脓毒症男性患者的碱剩余更高，凝血酶原时间更低。入院后第一天和第二天乳酸水平均升高。男性患者的手术预测因素包括初次肢体手术较少和二次脊柱手术较晚。脓毒症在接受单纯确定性手术的男性中更常见。几个因素，尤其是酸中毒和凝血功能障碍，与这一现象有关。初次肢体手术较少和二次脊柱手术延迟也与男性患者脓毒症风险较高有关。这些发现可能有助于识别适合接受单纯确定性手术的患者，并强调需要更多关于女性多发伤患者的数据。
