Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
J Am Coll Surg. 2012 Jan;214(1):18-25. doi: 10.1016/j.jamcollsurg.2011.09.020. Epub 2011 Nov 23.
Emergency department (ED) thoracotomy can be lifesaving. It can also lead to resource waste and exposure to blood-borne infections. We investigated the frequency with which ED thoracotomy was performed for inappropriate indications and the resulting societal costs.
This retrospective cohort study examined all trauma patients admitted directly from the scene of injury from 1992 to 2009 who underwent ED thoracotomy. The main outcomes included inappropriate ED thoracotomy. Secondary outcomes included resource use and societal costs for performing ED thoracotomy for improper indications. Specifically, we analyzed for operating room use, blood transfusions, ICU and hospital stay, needlestick injuries, survivor rate, and neurological outcomes in this group.
One hundred and twenty-three patients underwent ED thoracotomy during the study period. Of those, 63 (51%) were considered inappropriate. In this group, we observed no survivors, none became organ donors, 3 cases of needlestick injuries to health care providers occurred, and 335 U of blood products were used in their care. Also, 4 patients of 63 survived to the operating room and required a total of 6 separate operating room visits. Three of these patients had an ICU stay of 1 day and 1 died on day 5.
ED thoracotomy should be reserved for potentially salvageable patients, but discouraged for other indications. From the societal point of view, inappropriate use of the procedure resulted in substantial costs and waste of resources, exposure of health care providers to possible blood-borne infections, and offered no survival benefit.
急诊室（ED）开胸术可以救命。但它也可能导致资源浪费和血源感染的暴露。我们调查了因不适当的适应症而行 ED 开胸术的频率以及由此产生的社会成本。
本回顾性队列研究调查了 1992 年至 2009 年期间所有直接从受伤现场入院的创伤患者，他们接受了 ED 开胸术。主要结果包括不适当的 ED 开胸术。次要结果包括因不适当的适应症而行 ED 开胸术的资源使用和社会成本。具体来说，我们分析了该组的手术室使用、输血、重症监护病房和住院时间、针刺伤、存活率和神经学结果。
在研究期间，有 123 名患者接受了 ED 开胸术。其中 63 例（51%）被认为不适当。在这一组中，我们没有观察到幸存者，没有成为器官捐献者，发生了 3 例医护人员针刺伤，在他们的治疗中使用了 335 单位的血液制品。此外，63 例中有 4 例患者存活到手术室，总共需要 6 次单独的手术室就诊。其中 3 例患者在重症监护病房住了 1 天，1 例患者在第 5 天死亡。
ED 开胸术应保留给有潜在可挽救生命的患者，但不鼓励用于其他适应症。从社会的角度来看，该手术的不适当使用导致了大量的成本和资源浪费，使医护人员有可能接触到血源感染，并且没有带来生存获益。
