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Predictors of outcome in 101 patients requiring emergent thoracotomy for penetrating pulmonary injuries

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Operative interventions are uncommonly required for penetrating pulmonary injuries. Similarly, because their incidence is low, few series appear sporadically in the literature. Objectives of this study are to identify predictors of outcome for patients requiring emergent thoracotomy for penetrating pulmonary injuries and evaluate the use of tissue sparing versus resective techniques for their management.

Study design

This is a retrospective 169-month study of all patients with penetrating pulmonary injuries requiring thoracotomy. The main outcome measures are: physiologic parameters, AAST-OIS injury grade, surgical procedures and mortality. Statistical analysis includes univariate and stepwise logistic regression.

Results

101 patients required thoracotomy for penetrating pulmonary injuries. Mechanism of injury includes: gunshot wounds (GSW)—73 (72%), stab wounds (SW)—28 (33%). Mean systolic BP 97 ± 47, mean HR 92 ± 47, and mean admission pH 7.22 ± 0.17. Mean RTS 6.25 ± 2.7, mean ISS 36 ± 22. The mean estimated blood loss (EBL) was 5277 ± 4955 mls. Predictors of outcome are: admission pH (p = 0.0014), admission base deficit (p < 0.0001), packed red blood cells (PRBCs) transfused (p = 0.023), whole blood transfused (p < 0.01). A total of 143 procedures were required in 101 patients: tissue sparing 114 (80%) versus resective procedures 29 (20%). Only pneumonectomy (p = 0.024) predicted outcome. Overall survival 64/101–64%. American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) injury grades I–III versus IV–VI predicts survival (p < 0.001). Stepwise logistic regression identified AAST-OIS injury grades IV–VI (p = 0.007; OR 6.38 [95% CI 1.64–24.78]), intraoperative dysrhythmias (p = 0.003; OR 17.38 [95% CI 2.59–116.49]) and associated cardiac injuries (p = 0.02; OR 8.74 [95% CI 1.37–55.79]) as independent predictors of outcome.

Conclusions

Predictors of outcome for penetrating pulmonary injuries requiring thoracotomy are identified and must be taken into account in their operative management. Tissue sparing techniques—stapled pulmonary tractotomy is once again validated, and it remains effective as the mainstay for their management; however, only pneumonectomy predicts outcome. AAST-OIS injury grades IV–VI predict outcome with higher injury grades requiring resective procedures.

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Authors and Affiliations

  1. Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 601 North 30th Street, Suite 3701, Omaha, NE, 68131-2137, USA

    J. A. Asensio, O. A. Ogun, F. N. Mazzini, A. J. Perez-Alonso, L. M. Garcia-Núñez & P. Petrone

Authors
  1. J. A. Asensio
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  2. O. A. Ogun
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  3. F. N. Mazzini
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  4. A. J. Perez-Alonso
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  5. L. M. Garcia-Núñez
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  6. P. Petrone
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Contributions

Study conception and design: JAA. Acquisition of data: PP, ALP, LMG. Analysis and interpretation of data: JAA, PP, AJP, LMG, FNM. Drafting of manuscript: JAA, OAO. Critical revision: JAA, OAO

Corresponding author

Correspondence to J. A. Asensio.

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Conflict of interest

Juan A. Asensio, Oluwaseye Ayoola Ogun, Federico N. Mazzini, Alejandro J. Perez-Alonso, Luis M. Garcia-Núñez, and Patrizio Petrone declare that they have no conflict of interest.

Research involving human participants

Approval/Exempt was obtained from the Institutional Review Board (IRB).

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Inform consent was not required as this is a retrospective study that used prospectively collected de-identified data.

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Asensio, J.A., Ogun, O.A., Mazzini, F.N. et al. Predictors of outcome in 101 patients requiring emergent thoracotomy for penetrating pulmonary injuries. Eur J Trauma Emerg Surg 44, 55–61 (2018). https://doi.org/10.1007/s00068-017-0802-x

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  • DOI: https://doi.org/10.1007/s00068-017-0802-x

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