TY - JOUR
T1 - Surgical outcomes after trauma pneumonectomy
T2 - Revisited
AU - Matsushima, Kazuhide
AU - Aiolfi, Alberto
AU - Park, Caroline
AU - Rosen, David
AU - Strumwasser, Aaron
AU - Benjamin, Elizabeth
AU - Inaba, Kenji
AU - Demetriades, Demetrios
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Background: Trauma pneumonectomy has been historically associated with an exceedingly high morbidity and mortality. The recent advent of standardized reporting and data-collecting measures has facilitated large volume data analysis on predictors and outcomes of trauma pneumonectomy. The purpose of this study is to describe patient characteristics and outcomes of the patients who underwent trauma pneumonectomy in the modern era and identify clinical factors associated with postoperative mortality. Methods: Data between 2007 and 2014 from the National Trauma Data Bank were used for analysis, which included patients with both blunt and penetrating trauma who underwent pneumonectomy within 24 hours after admission. Patient characteristics, injury data, and outcomes were analyzed. Postoperative survival was estimated using the Kaplan-Meier method. Multivariate logistic regression analysis was performed to identify variables associated with postoperative mortality. Results: A total of 261 patients were included for analysis. Of those, 163 (62.5%) patients sustained penetrating trauma. Less invasive lung resections were performed before pneumonectomy in 12.6% of patients. First 24-hour and in-hospital mortality were significantly higher in blunt trauma patients compared with penetrating trauma patients (54.1% vs. 34.1% and 77.6% vs. 49.1%, respectively; p < 0.01). In our multivariate logistic regression analysis, an admission Glasgow Coma Scale of less than 9 (odds ratio [OR], 2.16, 95% CI: 1.24-3.77, p < 0.01) and associated brain injury (OR, 2.11, 95% CI: 1.01-4.42, p = 0.048) were significantly associated with in-hospital death, whereas penetrating mechanism (OR, 0.36, 95% CI 0.19-0.70, p < 0.01) and less invasive lung resections before pneumonectomy (OR, 0.39, 95%CI: 0.17-0.87, p = 0.02) were significantly associated with survival to hospital discharge. Conclusion: Trauma pneumonectomy remains a highly morbid procedure even in the modern era and should be reserved for carefully selected patients.
AB - Background: Trauma pneumonectomy has been historically associated with an exceedingly high morbidity and mortality. The recent advent of standardized reporting and data-collecting measures has facilitated large volume data analysis on predictors and outcomes of trauma pneumonectomy. The purpose of this study is to describe patient characteristics and outcomes of the patients who underwent trauma pneumonectomy in the modern era and identify clinical factors associated with postoperative mortality. Methods: Data between 2007 and 2014 from the National Trauma Data Bank were used for analysis, which included patients with both blunt and penetrating trauma who underwent pneumonectomy within 24 hours after admission. Patient characteristics, injury data, and outcomes were analyzed. Postoperative survival was estimated using the Kaplan-Meier method. Multivariate logistic regression analysis was performed to identify variables associated with postoperative mortality. Results: A total of 261 patients were included for analysis. Of those, 163 (62.5%) patients sustained penetrating trauma. Less invasive lung resections were performed before pneumonectomy in 12.6% of patients. First 24-hour and in-hospital mortality were significantly higher in blunt trauma patients compared with penetrating trauma patients (54.1% vs. 34.1% and 77.6% vs. 49.1%, respectively; p < 0.01). In our multivariate logistic regression analysis, an admission Glasgow Coma Scale of less than 9 (odds ratio [OR], 2.16, 95% CI: 1.24-3.77, p < 0.01) and associated brain injury (OR, 2.11, 95% CI: 1.01-4.42, p = 0.048) were significantly associated with in-hospital death, whereas penetrating mechanism (OR, 0.36, 95% CI 0.19-0.70, p < 0.01) and less invasive lung resections before pneumonectomy (OR, 0.39, 95%CI: 0.17-0.87, p = 0.02) were significantly associated with survival to hospital discharge. Conclusion: Trauma pneumonectomy remains a highly morbid procedure even in the modern era and should be reserved for carefully selected patients.
KW - Morbidity
KW - Mortality
KW - Pneumonectomy
KW - Surgical outcomes
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=85013660226&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85013660226&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000001416
DO - 10.1097/TA.0000000000001416
M3 - Review article
C2 - 28230627
AN - SCOPUS:85013660226
SN - 2163-0755
VL - 82
SP - 927
EP - 932
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 5
ER -