Longer time to surgery for pelvic ring injuries is associated with increased systemic complications.

Summary

In a Level I trauma center cohort of 1,056 pelvic ring injury surgeries, operations within 48 hours had significantly fewer complications than those after 48 hours (17.8% vs 34.9%). Each additional hour of delay increased the odds of any complication by 0.4% and raised risks of sepsis, pneumonia, AKI, MI, and DVT; findings support expedited surgery and robust early resuscitation.

Key Findings

• 48-hour surgery threshold associated with lower overall complications (17.8% vs 34.9%).
• Each additional hour delay increased odds of any complication by 0.4%.
• Hourly delays raised odds of specific complications: sepsis (+0.7%), pneumonia (+0.4%), DVT (+0.3%), AKI (+0.3%), MI (+0.5%).
• Model suggested an inflection around 42 hours with rising overall complication odds thereafter.

Clinical Implications

Prioritize surgery within 48 hours for operable pelvic ring injuries when feasible; implement early resuscitation and surveillance for sepsis, pneumonia, ARDS, and thromboembolic events when delays are unavoidable.

Limitations

• Retrospective single-center design limits causal inference and generalizability
• Potential residual confounding (injury severity, resuscitation quality) not fully captured

Future Directions

Prospective multicenter studies to validate time thresholds and evaluate protocols prioritizing expedited fixation; assess causal effects via quasi-experimental designs.