Advertisement

Optimal time to thoracoscopy for trauma patients with retained hemothorax

      Abstract

      Background

      Retained hemothorax remains a common problem after thoracic trauma with associated morbidity and prolonged hospitalizations. The goal of this study was to examine the impact of time to video assisted thoracoscopic surgery (VATS) on pulmonary morbidity using a large, national data set.

      Methods

      Patients undergoing VATS for retained hemothorax within the first 14 days postinjury were identified from the Trauma Quality Improvement Program database over 5 years, ending in 2016. Demographics, mechanism, severity of injury, severity of shock, time to VATS, pulmonary morbidity, and mortality were recorded. Multivariable logistic regression analysis was performed to determine independent predictors of pulmonary morbidity. Youden’s index was then used to identify the optimal time to VATS.

      Results

      From the Trauma Quality Improvement Program database, 3,546 patients were identified. Of these, 2,355 (66%) suffered blunt injury. The majority were male (81%) with a median age and Injury Severity Score of 46 and 16, respectively. The median time to VATS was 134 hours. Both pulmonary morbidity (13 vs 17%, P = .004) and hospital length of stay (9 vs 12 days, P < .0001) were significantly reduced in patients undergoing VATS before 3.9 days. Multivariable logistic regression identified VATS during the first 7 days as the only modifiable risk factor significantly associated with reduced pulmonary morbidity (odds ratio 0.52; 95% confidence interval 0.43–0.63, P < .0001).

      Conclusion

      Patients undergoing VATS for retained hemothorax have significant morbidity and prolonged length of stay. VATS within the first week of admission results in fewer pulmonary complications and shorter length of stay. In fact, the optimal time to VATS was identified as 3.9 days and was the only modifiable risk factor associated with decreased pulmonary morbidity.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Meyer D.M.
        • Jessen M.E.
        • Wait M.A.
        • Estrera A.S.
        Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial.
        Ann Thorac Surg. 1997; 64 (discussion 1400–1391): 1396-1400
        • Scott M.F.
        • Khodaverdian R.A.
        • Shaheen J.L.
        • Ney A.L.
        • Nygaard R.M.
        Predictors of retained hemothorax after trauma and impact on patient outcomes.
        Eur J Trauma Emerg Surg. 2017; 43: 179-184
        • Prakash P.S.
        • Moore S.A.
        • Rezende-Neto J.B.
        • et al.
        Predictors of retained hemothorax in trauma: results of an Eastern Association for the Surgery of Trauma multi-institutional trial.
        J Trauma Acute Care Surg. 2020; 89: 679-685
        • Cohen N.S.
        • Braig Z.
        • Collins J.N.
        Prevalence and management of posttraumatic retained hemothorax in a level 1 trauma center.
        Am Surg. 2018; 84: e369-e371
        • Villegas M.I.
        • Hennessey R.A.
        • Morales C.H.
        • Londono E.
        Risk factors associated with the development of post-traumatic retained hemothorax.
        Eur J Trauma Emerg Surg. 2011; 37: 583-589
        • MacLeod J.B.
        • Ustin J.S.
        • Kim J.T.
        • Lewis F.
        • Rozycki G.S.
        • Feliciano D.V.
        The epidemiology of traumatic hemothorax in a level I trauma center: case for early video-assisted thoracoscopic surgery.
        Eur J Trauma Emerg Surg. 2010; 36: 240-246
        • DuBose J.
        • Inaba K.
        • Demetriades D.
        • et al.
        Management of post-traumatic retained hemothorax: a prospective, observational, multicenter AAST study.
        J Trauma Acute Care Surg. 2012; 72: 11-22
        • Oguzkaya F.
        • Akcali Y.
        • Bilgin M.
        Videothoracoscopy versus intrapleural streptokinase for management of post traumatic retained haemothorax: a retrospective study of 65 cases.
        Injury. 2005; 36: 526-529
        • Morales Uribe C.H.
        • Villegas Lanau M.I.
        • Petro Sanchez R.D.
        Best timing for thoracoscopic evacuation of retained post-traumatic hemothorax.
        Surg Endosc. 2008; 22: 91-95
        • Huang F.D.
        • Yeh W.B.
        • Chen S.S.
        • et al.
        Early management of retained hemothorax in blunt head and chest trauma.
        World J Surg. 2018; 42: 2061-2066
        • Lin H.L.
        • Huang W.Y.
        • Yang C.
        • et al.
        How early should VATS be performed for retained haemothorax in blunt chest trauma?.
        Injury. 2014; 45: 1359-1364
        • Smith J.W.
        • Franklin G.A.
        • Harbrecht B.G.
        • Richardson J.D.
        Early VATS for blunt chest trauma: a management technique underutilized by acute care surgeons.
        J Trauma. 2011; 71 (discussion 105–107): 102-105
        • Patel N.J.
        • Dultz L.
        • Ladhani H.A.
        • et al.
        Management of simple and retained hemothorax: a practice management guideline from the Eastern Association for the Surgery of Trauma.
        Am J Surg. 2021; 221: 873-884
        • Heniford B.T.
        • Carrillo E.H.
        • Spain D.A.
        • Sosa J.L.
        • Fulton R.L.
        • Richardson J.D.
        The role of thoracoscopy in the management of retained thoracic collections after trauma.
        Ann Thorac Surg. 1997; 63: 940-943
        • Ziapour B.
        • Mostafidi E.
        • Sadeghi-Bazargani H.
        • Kabir A.
        • Okereke I.
        Timing to perform VATS for traumatic-retained hemothorax (a systematic review and meta-analysis).
        Eur J Trauma Emerg Surg. 2020; 46: 337-346
        • DuBose J.
        • Inaba K.
        • Okoye O.
        • et al.
        Development of posttraumatic empyema in patients with retained hemothorax: results of a prospective, observational AAST study.
        J Trauma Acute Care Surg. 2012; 73: 752-757
        • Bradley M.
        • Okoye O.
        • DuBose J.
        • et al.
        Risk factors for post-traumatic pneumonia in patients with retained haemothorax: results of a prospective, observational AAST study.
        Injury. 2013; 44: 1159-1164
        • Kugler N.W.
        • Carver T.W.
        • Milia D.
        • Paul J.S.
        Thoracic irrigation prevents retained hemothorax: a prospective propensity scored analysis.
        J Trauma Acute Care Surg. 2017; 83: 1136-1141
        • Savage S.A.
        • Cibulas II, G.A.
        • Ward T.A.
        • Davis C.A.
        • Croce M.A.
        • Zarzaur B.L.
        Suction evacuation of hemothorax: a prospective study.
        J Trauma Acute Care Surg. 2016; 81: 58-62
        • Hendriksen B.S.
        • Kuroki M.T.
        • Armen S.B.
        • Reed M.F.
        • Taylor M.D.
        • Hollenbeak C.S.
        Lytic therapy for retained traumatic hemothorax: a systematic review and meta-analysis.
        Chest. 2019; 155: 805-815
        • Stiles P.J.
        • Drake R.M.
        • Helmer S.D.
        • Bjordahl P.M.
        • Haan J.M.
        Evaluation of chest tube administration of tissue plasminogen activator to treat retained hemothorax.
        Am J Surg. 2014; 207: 960-963
        • Choi J.
        • Villarreal J.
        • Andersen W.
        • et al.
        Scoping review of traumatic hemothorax: evidence and knowledge gaps, from diagnosis to chest tube removal.
        Surgery. 2021; 170: 1260-1267