Delayed repair for blunt XXXX : is it really equivalent to early repair?

@entity1 @entity1755 @entity772 @entity764 @entity3490 @entity204 @entity130
BACKGROUND: Blunt @entity764 (BTAI) is a severe injury that traditionally has mandated immediate surgical repair. Delaying operative intervention for BTAI can allow other life-threatening injuries to be managed first, but potentially increases the risk of @entity1755 and @entity204 . The objective of this study was to evaluate the outcome of delayed repair (DR) compared with early repair (ER) for BTAI and to assess the effectiveness of a protocol for medical control of systolic blood pressure and heart rate in those @entity1 whose repairs were delayed. METHODS: This study is a retrospective review of University of Michigan Health System (UMHS) data from January 1, 1992, through @entity3490 , 2003. ER was defined as operative repair within 16 hours from the time of injury. A similar analysis was conducted for @entity1 with BTAI selected from the National @entity130 Data Bank. RESULTS: For the UMHS data, there were 45 @entity1 in the DR group and 33 @entity1 in the ER group. Mortality in the ER group versus the DR group was 9% versus 20%. Multivariate analysis adjusting for age, Injury Severity Score, abdominal Abbreviated Injury Scale score, Glasgow @entity772 Scale score, and intubation status demonstrated an odds ratio for @entity204 from ER compared with DR of 1.72 (p = 0.57). @entity1 undergoing DR had an absolute increase in hospital length of stay (33.1 vs. 20.9 days) and complication rate (2.1 vs. 1.5 incidents per @entity1 ). A similar result was obtained for multivariate analysis of the National @entity130 Data Bank data, with an odds ratio of 1.40 (p = 0.51) for @entity204 from ER versus DR. UMHS @entity1 whose repairs were delayed achieved target systolic blood pressure and heart rate for 76% and 74% of the hourly measurements recorded, respectively. CONCLUSION: @entity1 with BTAI can safely undergo delayed aortic repair if other injuries warrant a higher treatment priority without increasing their overall risk of mortality. Delayed repair is, however, associated with a higher complication rate.
