Urgent Thoracotomy for Blunt Chest Trauma

Material and Methods PatientsThe Department of Thoracic Surgery of the Hospital of Lithuanian University of Health Sciences provides specialized surgical aid for nearly 1 million inhabitants.From the beginning of 2002 to the end of 2011, we treated 1,826 (age 40.32 ± 16.44, range 18-89 years) patients who sustained BCT due to traffic (67%), occupational (25%), criminal (5%), and other (3%) accidents.Only adult patients were included in this study because patients younger than 18 years are treated by pediatric surgeons in our clinic.A detailed retrospective analysis was completed involving all patients who underwent UT. Management of blunt chest traumaBCT management was organized according to our Clinic's protocol presented in the form of algorithms for diagnosis and treatment of most dangerous chest injuries and traumatic syndromes (Figures 1 and 2).The initial actions were the evaluation of the patient's clinical condition, chest and associated injuries, intrapleural hemorrhage (hemothorax) and/or air leakage (aeropathic syndrome). Assessment of injuries and evaluation of patients clinical conditionThe severity of injuries was assessed using the New Injury Severity AbstractThe majority of patients with blunt chest trauma are treated conservatively or using minor thoracic surgical procedures, and video-assisted thoracoscopic surgery.However, in a small but significant number of patients an urgent exploration of the chest via, thoracotomy is unavoidable.In those cases thoracotomy means not only a surgical incision, but the most invasive (aggressive) method used in the complex treatment of blunt chest trauma.The objectives of this study were the following: (2) to specify the indications for urgent thoracotomy, regarding the possibilities of video-assisted thoracoscopic surgery; [2] to reveal the main factors influencing outcomes following urgent thoracotomy.A retrospective review of 1,826 patients (age 40.3 ± 12.4, range 18 -79 years) with blunt chest trauma over the period of 10 years (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) was performed.A detailed analysis was completed involving 102 (5.6%) patients who underwent urgent thoracotomy.We recorded patients' age and gender, the mechanism of injury, clinical condition, NISS, injuries of the chest, intrapleural hemorrhage (hemothorax) and air leakage (aeropathic syndrome), methods of treatment, mortality and morbidity occurring within 30 days following urgent thoracotomy.Student's t and chisquared tests were used for the comparison of the data.The level of statistical significance was set at p<0.05.Comparing to the previous period (1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000), video-assisted thoracoscopic surgery has reduced twice (to 5.6%) the incidence rate of urgent thoracotomy.The overall postoperative morbidity and mortality rate was 65.7% and 8.8%, respectively.Video-assisted thoracoscopic approach is the method of choice for clinically stable patients.However, when surgical intervention is unavoidable for clinically unstable patients, it should be started with urgent thoracotomy.Multiple fractures of ribs and/or sternum that caused flail chest, injuries of lungs, and intensive intrapleural hemorrhage, resulting in patient's clinically unstable condition were the main factors influencing morbidity and mortality following urgent thoracotomy due to blunt chest trauma. Journal of Trauma & Treatment