N. Saraswat, Nicole Werwie, Jin Wu, Danielle Hery, E. Saunders, Hannah Bundy, J. Elliott, B. Goslin, William B. DeVoe
Objectives: Surgical stabilization of rib fractures (SSRF) improves outcomes in patients with flail chest and displaced fractures with impaired pulmonary function. Elderly and frail patients with such injuries are at risk for significant morbidity and may benefit from SSRF. The 5-factor modified frailty index (mFI-5) is a validated predictor of postoperative outcomes. The purpose of this study is to evaluate the relationship between frailty and outcomes following SSRF at a tertiary care trauma center. Methods: A retrospective review of patients undergoing SSRF from 2015 to 2019. Patients over 18 years old with two or more displaced fractures were included in the study. Exclusion criteria were isolated fracture, traumatic brain injury, and pulmonary contusion. Frail patients were defined by an mFI-5 score 2 or greater. Chi-square analysis, Fischer's exact test, and Student's t-test were used for comparative analysis as appropriate. P < 0.05 was considered statistically significant. Results: One hundred and fifty-four patients met inclusion criteria. Forty-eight patients were designated frail and 106 nonfrail. The mean number of fractures was similar between frail and nonfrail groups (7.0 vs. 7.3, P = 0.685). Injury Severity Score was lower in the frail group (14.5 vs. 17.8, P = 0.02). Inpatient mortality (P = 0.312), rates of pneumonia, end-organ dysfunction, and surgical site infections were similar (P > 0.05). Intensive care unit admission (47.9% vs. 29.2%, P = 0.025) and tracheostomy rates (P = 0.009) were increased in the frail group. Frailty also increased the risk of prolonged mechanical ventilation >48 h on multivariate analysis. Conclusion: Frail patients, stratified using mFI 5 score, experienced similar rates of multiple postoperative outcomes, including mortality, but had increased rates of prolonged ventilation and tracheostomy. Despite observed but expected increased morbidity in these patients, the similar complication and mortality rates suggest a role for surgical stabilization of severe rib fractures in frail patients.
{"title":"Postoperative outcomes following surgical stabilization of rib fractures stratified by 5-factor modified frailty index","authors":"N. Saraswat, Nicole Werwie, Jin Wu, Danielle Hery, E. Saunders, Hannah Bundy, J. Elliott, B. Goslin, William B. DeVoe","doi":"10.4103/jctt.jctt_1_22","DOIUrl":"https://doi.org/10.4103/jctt.jctt_1_22","url":null,"abstract":"Objectives: Surgical stabilization of rib fractures (SSRF) improves outcomes in patients with flail chest and displaced fractures with impaired pulmonary function. Elderly and frail patients with such injuries are at risk for significant morbidity and may benefit from SSRF. The 5-factor modified frailty index (mFI-5) is a validated predictor of postoperative outcomes. The purpose of this study is to evaluate the relationship between frailty and outcomes following SSRF at a tertiary care trauma center. Methods: A retrospective review of patients undergoing SSRF from 2015 to 2019. Patients over 18 years old with two or more displaced fractures were included in the study. Exclusion criteria were isolated fracture, traumatic brain injury, and pulmonary contusion. Frail patients were defined by an mFI-5 score 2 or greater. Chi-square analysis, Fischer's exact test, and Student's t-test were used for comparative analysis as appropriate. P < 0.05 was considered statistically significant. Results: One hundred and fifty-four patients met inclusion criteria. Forty-eight patients were designated frail and 106 nonfrail. The mean number of fractures was similar between frail and nonfrail groups (7.0 vs. 7.3, P = 0.685). Injury Severity Score was lower in the frail group (14.5 vs. 17.8, P = 0.02). Inpatient mortality (P = 0.312), rates of pneumonia, end-organ dysfunction, and surgical site infections were similar (P > 0.05). Intensive care unit admission (47.9% vs. 29.2%, P = 0.025) and tracheostomy rates (P = 0.009) were increased in the frail group. Frailty also increased the risk of prolonged mechanical ventilation >48 h on multivariate analysis. Conclusion: Frail patients, stratified using mFI 5 score, experienced similar rates of multiple postoperative outcomes, including mortality, but had increased rates of prolonged ventilation and tracheostomy. Despite observed but expected increased morbidity in these patients, the similar complication and mortality rates suggest a role for surgical stabilization of severe rib fractures in frail patients.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"7 1","pages":"4 - 9"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48833253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mario-Fernando Lopez, S. Martínez, Carlos-Andres Carvajal
Background: This investigation aimed to describe factors associated with early complications of surgical management due to penetrating laryngotracheal trauma in Colombia. Materials and Methods: A descriptive and retrospective cohort study was carried out; bivariate analysis using Pearson's Chi-square and Fisher's exact test was utilized to find associations with morbidity outcomes. Results: Between 2005 and 2019, 50 patients with penetrating laryngotracheal injuries underwent surgery; the median age was 29.5 years (interquartile ranges = 24.0–39.7), wherein 92% were male. The trachea was the most affected organ in 74% of patients, and lesions associated with laryngotracheal trauma were reported in 50% of patients. Cervicotomy was the surgical approach in 92% of patients. The 30-day overall morbidity was 24%, and mortality was 6%; dehiscence of the primary repair, or anastomosis, was present in 10% of the patients: 2% partial and 8% complete. Dehiscence was associated with infection (P = 0.002). Early stenosis was described in 10% of the patients; association was found between stenosis and dehiscence (P = 0.001), infection (P = 0.001), and reoperation (P = 0.001). Finally, infection was present in 8% of the patients and was indeed associated to the requirement of postoperative intensive care unit (ICU) hospitalization (P = 0.003). Conclusions: Limited information is available about factors related to early complications in laryngotracheal trauma. Nonetheless, in this series, a statistically significant association was found between early dehiscence of the primary repair, or anastomosis, and infection. Moreover, early stenosis was associated with dehiscence, infection, and reoperation. Finally, early infection was associated with the requirement of postoperative ICU hospitalization.
{"title":"Factors associated with early complications of surgical management due to penetrating laryngotracheal trauma in Colombia","authors":"Mario-Fernando Lopez, S. Martínez, Carlos-Andres Carvajal","doi":"10.4103/jctt.jctt_4_22","DOIUrl":"https://doi.org/10.4103/jctt.jctt_4_22","url":null,"abstract":"Background: This investigation aimed to describe factors associated with early complications of surgical management due to penetrating laryngotracheal trauma in Colombia. Materials and Methods: A descriptive and retrospective cohort study was carried out; bivariate analysis using Pearson's Chi-square and Fisher's exact test was utilized to find associations with morbidity outcomes. Results: Between 2005 and 2019, 50 patients with penetrating laryngotracheal injuries underwent surgery; the median age was 29.5 years (interquartile ranges = 24.0–39.7), wherein 92% were male. The trachea was the most affected organ in 74% of patients, and lesions associated with laryngotracheal trauma were reported in 50% of patients. Cervicotomy was the surgical approach in 92% of patients. The 30-day overall morbidity was 24%, and mortality was 6%; dehiscence of the primary repair, or anastomosis, was present in 10% of the patients: 2% partial and 8% complete. Dehiscence was associated with infection (P = 0.002). Early stenosis was described in 10% of the patients; association was found between stenosis and dehiscence (P = 0.001), infection (P = 0.001), and reoperation (P = 0.001). Finally, infection was present in 8% of the patients and was indeed associated to the requirement of postoperative intensive care unit (ICU) hospitalization (P = 0.003). Conclusions: Limited information is available about factors related to early complications in laryngotracheal trauma. Nonetheless, in this series, a statistically significant association was found between early dehiscence of the primary repair, or anastomosis, and infection. Moreover, early stenosis was associated with dehiscence, infection, and reoperation. Finally, early infection was associated with the requirement of postoperative ICU hospitalization.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"7 1","pages":"10 - 14"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47462794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Miguel Martinez Arias, Ulises García, Juan Omana Toledo, Linda Mercado Mercado Sanchez
Background: Current pathologies and the concepts applied for chest trauma, both for revision of thoracic cavity and to solve same traumatisms, have allowed to develop minimal surgery approach techniques for the resolution of multiple nosologies, thanks to their various benefits, currently this has been classified as a vanguard surgical technique worldwide. Material and Methods: Patients undergoing ribs fixation with minimal invasive technique, at ISSEMYM Medical Center, Thoracic Surgery Service, were analyzed according to age, gender, number of ribs fixed, days of hospital stay, days with endopleural tube, type of anesthesia, and complications. We present a series of cases with retrospective, descriptive design in a period of 72 months. Results: This is the largest case series reported for fixing ribs by minimal invasive approach, a final sample n = 103 was used, and favorable results and description of the same technique were described. The analyzed number of fixed ribs presented an average of 3.8 ribs fixed per patient. The average of hospital stay days was 5.08 days, after the procedure. Moreover, the oldest patient undergoing this procedure was 89 years old and the youngest was 23 years old. Conclusions: The technique of fixing ribs by minimal invasive approach continues to be a choice technique to reduce postoperative complications and reduce days of hospital stay, it is a reproducible, safe and pioneering technique for chest surgery, even in geriatric patients.
{"title":"Minimal invasive approach for rib fractures: Feasibility and safety in a single-center experience","authors":"Miguel Martinez Arias, Ulises García, Juan Omana Toledo, Linda Mercado Mercado Sanchez","doi":"10.4103/jctt.jctt_6_22","DOIUrl":"https://doi.org/10.4103/jctt.jctt_6_22","url":null,"abstract":"Background: Current pathologies and the concepts applied for chest trauma, both for revision of thoracic cavity and to solve same traumatisms, have allowed to develop minimal surgery approach techniques for the resolution of multiple nosologies, thanks to their various benefits, currently this has been classified as a vanguard surgical technique worldwide. Material and Methods: Patients undergoing ribs fixation with minimal invasive technique, at ISSEMYM Medical Center, Thoracic Surgery Service, were analyzed according to age, gender, number of ribs fixed, days of hospital stay, days with endopleural tube, type of anesthesia, and complications. We present a series of cases with retrospective, descriptive design in a period of 72 months. Results: This is the largest case series reported for fixing ribs by minimal invasive approach, a final sample n = 103 was used, and favorable results and description of the same technique were described. The analyzed number of fixed ribs presented an average of 3.8 ribs fixed per patient. The average of hospital stay days was 5.08 days, after the procedure. Moreover, the oldest patient undergoing this procedure was 89 years old and the youngest was 23 years old. Conclusions: The technique of fixing ribs by minimal invasive approach continues to be a choice technique to reduce postoperative complications and reduce days of hospital stay, it is a reproducible, safe and pioneering technique for chest surgery, even in geriatric patients.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"7 1","pages":"15 - 20"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45107539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of rib fractures following blunt chest wall trauma: Are we there yet?","authors":"B. Patel","doi":"10.4103/jctt.jctt_5_22","DOIUrl":"https://doi.org/10.4103/jctt.jctt_5_22","url":null,"abstract":"","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"7 1","pages":"2 - 3"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70788280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is flail chest correctly defined: A new definition is suggested","authors":"M. Rashid","doi":"10.4103/jctt.jctt_9_22","DOIUrl":"https://doi.org/10.4103/jctt.jctt_9_22","url":null,"abstract":"","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"7 1","pages":"1 - 1"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47227237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gustavo Cruz, Álvaro Sánchez, J. Puyana, M. Velásquez
Introduction: Increased interests in surgical approaches for multiple rib fractures in trauma patients have emerged lately. A novel strategy based on intraoperative ultrasound (US) assessment to locate these fractures has been proposed to perform smaller incisions for thoracic wall reconstructions. We aimed to describe variations of site, size, and direction of surgical incisions before and after US use intraoperatively for localization of rib fractures. Materials and Methods: In this pilot study, ten trauma patients with multiple rib fractures requiring thoracic wall reconstruction were prospectively included during a 9-month period. Computer tomography of the thorax was used for determining surgical incisions. Before surgical incision, US was used for the identification of rib fractures and for marking a different surgical incision. In each patient, qualitative comparisons of surgical incision marks before and after US were performed. Results: The qualitative analysis demonstrated that five patients (5/10) had a change in the direction of the incision and also in five patients (5/10) there was a change in the size of the incision. In those five patients in whom the length and size of the incision changed, there was a median length reduction of the incision of 3 cm (interquartile range 2–3). Conclusions: In this pilot study, we observed that trauma patients with multiple rib fractures requiring thoracic wall reconstruction may benefit from intraoperative assessment of US for targeted surgical planning. US might offer advantages for surgical planning before defining the final surgical approach.
{"title":"Intraoperative evaluation by ultrasound of multiple rib fractures in trauma patients","authors":"Gustavo Cruz, Álvaro Sánchez, J. Puyana, M. Velásquez","doi":"10.4103/jctt.jctt_7_20","DOIUrl":"https://doi.org/10.4103/jctt.jctt_7_20","url":null,"abstract":"Introduction: Increased interests in surgical approaches for multiple rib fractures in trauma patients have emerged lately. A novel strategy based on intraoperative ultrasound (US) assessment to locate these fractures has been proposed to perform smaller incisions for thoracic wall reconstructions. We aimed to describe variations of site, size, and direction of surgical incisions before and after US use intraoperatively for localization of rib fractures. Materials and Methods: In this pilot study, ten trauma patients with multiple rib fractures requiring thoracic wall reconstruction were prospectively included during a 9-month period. Computer tomography of the thorax was used for determining surgical incisions. Before surgical incision, US was used for the identification of rib fractures and for marking a different surgical incision. In each patient, qualitative comparisons of surgical incision marks before and after US were performed. Results: The qualitative analysis demonstrated that five patients (5/10) had a change in the direction of the incision and also in five patients (5/10) there was a change in the size of the incision. In those five patients in whom the length and size of the incision changed, there was a median length reduction of the incision of 3 cm (interquartile range 2–3). Conclusions: In this pilot study, we observed that trauma patients with multiple rib fractures requiring thoracic wall reconstruction may benefit from intraoperative assessment of US for targeted surgical planning. US might offer advantages for surgical planning before defining the final surgical approach.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"6 1","pages":"28 - 31"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42173131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Towe, Avanti Badrinathan, V. Ho, Katelynn C. Bachman, S. Worrell, M. Moorman, P. Linden, F. Pieracci
Background: Increased age and number of rib fractures are known to increase the risk of mortality. The impact of comorbidities on the outcomes of patients with rib fractures has not previously been described. We hypothesized that specific medical comorbidities are associated with increased risk of morbidity and mortality following rib fracture. Methods: Patients with multiple rib fractures or flail chest were identified in the National Inpatient Sample by ICD-10 code from the 4th quarter of 2015 through 2016. Comorbidities were categorized into Elixhauser comorbidity groups, and injury severity was estimated using the Injury Severity Score (ISS). The composite adverse outcome was defined as death, pneumonia, tracheostomy, or discharge to a short-term acute care facility. Multivariable logistic regression was performed with covariates chosen through backward selection from the univariate model to determine the relationship of outcomes to demographic variables and comorbidities with alpha set to 0.001. Results: Totally 26,289 patients met inclusion criteria. Composite adverse outcomes occurred in 5,132 (19.5%) patients. Profound ISS (OR 6.013), severe ISS (odds ratio [OR] 2.569), fluid and electrolyte disorder (OR 2.471), and paralysis (OR 2.372) were most associated with adverse outcomes. Within causes of injury, motor vehicle was associated with increased risk of adverse outcome (OR 1.322). Flail chest was also independently associated with adverse outcome (OR 1.816). Conclusion: Morbidity and mortality following rib fracture occurred in approximately one-fifth of patients, especially those with high ISS or associated medical comorbidities. This data can be used for risk stratification and identification of high-risk patients for escalation of care.
{"title":"Which comorbidities matter most in patients with multiple rib fractures? An analysis of the national inpatient sample","authors":"C. Towe, Avanti Badrinathan, V. Ho, Katelynn C. Bachman, S. Worrell, M. Moorman, P. Linden, F. Pieracci","doi":"10.4103/jctt.jctt_14_21","DOIUrl":"https://doi.org/10.4103/jctt.jctt_14_21","url":null,"abstract":"Background: Increased age and number of rib fractures are known to increase the risk of mortality. The impact of comorbidities on the outcomes of patients with rib fractures has not previously been described. We hypothesized that specific medical comorbidities are associated with increased risk of morbidity and mortality following rib fracture. Methods: Patients with multiple rib fractures or flail chest were identified in the National Inpatient Sample by ICD-10 code from the 4th quarter of 2015 through 2016. Comorbidities were categorized into Elixhauser comorbidity groups, and injury severity was estimated using the Injury Severity Score (ISS). The composite adverse outcome was defined as death, pneumonia, tracheostomy, or discharge to a short-term acute care facility. Multivariable logistic regression was performed with covariates chosen through backward selection from the univariate model to determine the relationship of outcomes to demographic variables and comorbidities with alpha set to 0.001. Results: Totally 26,289 patients met inclusion criteria. Composite adverse outcomes occurred in 5,132 (19.5%) patients. Profound ISS (OR 6.013), severe ISS (odds ratio [OR] 2.569), fluid and electrolyte disorder (OR 2.471), and paralysis (OR 2.372) were most associated with adverse outcomes. Within causes of injury, motor vehicle was associated with increased risk of adverse outcome (OR 1.322). Flail chest was also independently associated with adverse outcome (OR 1.816). Conclusion: Morbidity and mortality following rib fracture occurred in approximately one-fifth of patients, especially those with high ISS or associated medical comorbidities. This data can be used for risk stratification and identification of high-risk patients for escalation of care.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"6 1","pages":"22 - 27"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43161281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trauma represents a significant portion of the world's morbidity and mortality. Chest trauma accounts for approximately 25% of mortality in trauma patients, and this rate is much higher in patients with polytraumatic injuries. The thoracic cavity contains three major anatomical systems: the airway, lungs, and the cardiovascular system including the thoracic duct. Blunt or penetrating trauma can cause significant disruption to each of these systems that can quickly prove to be life threatening unless rapidly identified and treated. In the present article, the authors present a review of the thoracic duct injury evaluation and treatment.
{"title":"Thoracic duct injury: An up to date","authors":"José Ruiz Pier, M. Rashid","doi":"10.4103/jctt.jctt_19_21","DOIUrl":"https://doi.org/10.4103/jctt.jctt_19_21","url":null,"abstract":"Trauma represents a significant portion of the world's morbidity and mortality. Chest trauma accounts for approximately 25% of mortality in trauma patients, and this rate is much higher in patients with polytraumatic injuries. The thoracic cavity contains three major anatomical systems: the airway, lungs, and the cardiovascular system including the thoracic duct. Blunt or penetrating trauma can cause significant disruption to each of these systems that can quickly prove to be life threatening unless rapidly identified and treated. In the present article, the authors present a review of the thoracic duct injury evaluation and treatment.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"6 1","pages":"15 - 21"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46765570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：