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Surgical outcomes after trauma pneumonectomy: Revisited

Matsushima, Kazuhide MD; Aiolfi, Alberto MD; Park, Caroline MD, MPH; Rosen, David MD; Strumwasser, Aaron MD; Benjamin, Elizabeth MD, PhD; Inaba, Kenji MD; Demetriades, Demetrios MD, PhD

Journal of Trauma and Acute Care Surgery: May 2017 - Volume 82 - Issue 5 - p 927–932
doi: 10.1097/TA.0000000000001416
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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.

LEVEL OF EVIDENCE Prognostic study, level IV.

From the Division of Acute Care Surgery (K.M., A.A., C.P., D.R., A.S., E.B., K.I., and D.D.), University of Southern California, Los Angeles, California.

Submitted: December 14, 2016, Revised: January 28, 2017, Accepted: February 15, 2017, Published online: February 23, 2017.

Address for reprints: Kazuhide Matsushima, MD, 2051 Marengo Street, Inpatient Tower (C), C5L100, Los Angeles, CA 90033; email: kazuhide.matsushima@med.usc.edu.

© 2017 Lippincott Williams & Wilkins, Inc.