Survival rate in patients undergoing emergency thoracotomy for penetrating and blunt thoracic trauma-A retrospective analysis

Abstract

Objective: To determine the survival rate in patients undergoing emergency thoracotomy for penetrating and blunt thoracic trauma. Material and Methods: This retrospective observational study was conducted in Cardiothoracic surgery unit, MTI-LRH, Peshawar, KPK, Pakistan from 1st January 2019 to 31st December 2022. Clinical record of all patients who underwent emergency thoracotomy were retrospectively analyzed. Patients of all ages, both sexes and having isolated penetrating and blunt chest trauma were included in the study, Patients having emergency department thoracotomy or urgent thoracotomy post-surgical and post poly trauma were excluded from the study. Emergency thoracotomy was performed through posterolateral thoracotomy by the consultant with ICU back-up. Survival rate during hospital stay was determined by statistical analysis using latest SPSS version. Results: Out of 113 emergency thoracotomy cases, 67 were penetrating chest trauma and 46 were blunt chest trauma, male to female ratio was 3:1 with a mean age of 23 years. Among 67 penetrating chest trauma cases, 49 were firearm injuries while stab injury cases were 18. Thirty-one road traffic accident cases were reported in 46 blunt chest trauma cases, while 15 blunt chest trauma patients presented with the history of fall. Overall mortality was 9.73% and was higher in the blunt chest trauma group than in the penetrating chest trauma group 13.04% vs 7.46%. Overall survival rate was 90.26% and was higher in penetrating chest trauma group 92.53%, than in blunt chest trauma group 86.95%. Conclusion: Survival rate after emergency thoracotomy was higher in patients with penetrating chest trauma. The emergency thoracotomy should be performed in both penetrating and blunt chest trauma as quickly as possible and should be limited to damage control. It also emerges that blood loss, acidosis and hypothermia in chest trauma patients need to be treated extremely aggressively before, during, and after emergency thoracotomy.