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Timing of planned reoperation after damage control surgery in patients with
trauma: a systematic review and meta-analysis
#MMPMID41162987
Seo D
; Woo HY
; Heo I
; Jung K
; Jung H
World J Emerg Surg
2025[Oct]; 20
(1
): 82
PMID41162987
show ga
BACKGROUND: Damage control surgery (DCS) is the standard approach for managing
severely injured patients with trauma who present with extreme physiological
derangements. The optimal timing for planned reoperation after the initial DCS
remains contentious. Although traditional guidelines recommend reoperation within
24-48 h, emerging evidence suggests this interval may not be appropriate for all
patients. This systematic review and meta-analysis evaluated the impact of early
versus delayed planned reoperations on the clinical outcomes in patients with
trauma following DCS. METHODS: This review adhered to the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (PROSPERO
registration: CRD420251049990). PubMed, Embase, and the Cochrane Library were
searched from inception to 28 July 2025. Eligible studies compared early (??48 h)
with delayed (>?48 h) planned reoperation after DCS in adult patients with
trauma. The primary outcome was re-bleeding; secondary outcomes were in-hospital
mortality and infection rates. Study quality was assessed using the
Newcastle-Ottawa Scale, and the certainty of evidence was graded using the GRADE
approach. Meta-analysis was conducted using random-effects models. RESULTS: Seven
retrospective cohort studies involving 965 patients met the inclusion criteria.
No prospective or randomised controlled trials were identified. Early planned
reoperation was associated with significantly higher re-bleeding rates (OR 3.01;
95% CI 1.21-7.51; P?=?0.02), indicating three-fold higher odds of re-bleeding
with early intervention compared to delayed reoperation. No significant
differences were observed in mortality (OR 0.79; 95% CI 0.51-1.23; P?=?0.29; I(2)
= 0%) or infection rates (OR 1.05; 95% CI 0.54-2.05; P?=?0.89; I(2) = 65%).
CONCLUSIONS: Delayed planned reoperation beyond 48 h after DCS significantly
reduces the risk of re-bleeding, without increasing mortality or infection rates.
These findings support an individualised approach to reoperation timing guided by
patient physiology, rather than rigid adherence to conventional 24- to 48-h
protocols.
|*Reoperation/methods/standards/statistics & numerical data
[MESH]
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