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Title: Time from Trauma to Surgery: Causes and Complications of Delayed Operative Management
Author: Zahra Ali, Leicester Medical School
Background: Timely surgical intervention is critical in trauma care. Delays increase morbidity, mortality, and resource use, yet their causes and consequences remain incompletely characterised.
Objective: To identify the causes of delayed surgery in trauma patients and evaluate impacts on clinical and non-clinical outcomes.
Methods: A structured literature review of PubMed (2019– 2024) was conducted following PRISMA principles. Search terms included combinations of “trauma,” “time-to-surgery,” “delay,” “mortality,” and “complications.” Inclusion criteria comprised peer-reviewed studies of trauma patients reporting time-to-surgery and associated outcomes across abdominal, orthopaedic, facial, and spinal injuries. Exclusion criteria included non-traumatic surgical cohorts, case reports, and non-English publications. ‘Delay’ was defined as time-to-surgery exceeding 24 hours where clinically indicated, or as defined by individual studies. Study selection followed a PRISMA-style flow (identification, screening, eligibility, inclusion). Data on causes of delay, mortality, complications, and length of stay (LOS) were extracted. Limitations identified included single reviewer technique, differing definitions of ‘delay’ across studies and potential of correlational conclusions.
Results: Of the identified studies, a subset met inclusion criteria after screening and eligibility assessment. Delays were attributed to two principal categories: patient-related factors (physiological instability, high injury severity score, comorbidities) and modifiable system-level factors (including operating room access, scheduling, interdepartmental coordination, resource availability.) Operating room access was commonly identified as a leading contributor; in abdominal trauma, each additional minute in emergency department–to–operating room time increased the odds of hemorrhagic mortality by 1.8%, with risk rising markedly beyond approximately 91 minutes (Park et al., 2025). In operative facial trauma, the median time to surgery was 2 days (IQR 1–2), with procedures performed after 48 hours associated with significantly higher complication risk (OR 4.72, 95% CI 1.49–16.6) (Sharma et al., 2024). In spinal trauma, delayed surgery (>72 hours) was associated with increased perioperative complications compared with earlier intervention (Adegeest et al., 2025). These findings are consistent with recent literature demonstrating significant associations between delayed operative care and adverse outcomes.
Conclusion: Minimising surgical delay is a critical determinant of trauma outcomes. This review distinguishes necessary clinical stabilisation from avoidable system inefficiencies, highlighting actionable targets for improvement. Efforts must shift from documenting delays to eliminating them through targeted interventions, including dynamic OR prioritisation and implementation of ‘Decision-to-Incision’ time standards. Future research should establish injury-specific time thresholds and evaluate the clinical and economic impact of system-level interventions on survival and complication rates.