Grant Heather M, Knee Alexander, Tirabassi Michael V
Department of Surgery, UMass Medical School - Baystate, Springfield, MA; Institute for Healthcare Delivery and Population Science, UMass Medical School - Baystate, Springfield, MA.
Office of Research, Epidemiology/Biostatistics Research Core, Baystate Medical Center, Springfield, MA; Department of Medicine, UMass Medical School - Baystate, Springfield, MA.
J Surg Res. 2022 Jan;269:83-93. doi: 10.1016/j.jss.2021.08.007. Epub 2021 Sep 14.
Few studies have identified factors associated with successful VATS or thoracotomy as the initial operative strategy among patients with traumatic hemothorax.
We performed an exploratory analysis using the 2008 to 2017 TQP database. We identified all patients aged 18 to 89 years with traumatic hemothorax who were treated with tube thoracostomy alone in the first 24-hours of admission, followed by VATS or thoracotomy. Logistic regression was used to identify factors associated with successful VATS (no conversion or reoperation) or thoracotomy (no reoperation) as the initial operative strategy.
Among 2052 patients managed with initial VATS after chest tube drainage, 1710 (83%) were successful, while 263 (13%) were converted to thoracotomy and 79 (4%) required reoperation. On multivariable analysis, poor GCS (OR = 0.96 [95% CI = 0.94-0.99]), major injury (OR = 0.69 [95% CI = 0.53-0.90]), and diaphragmatic injury (OR = 0.42 [95% CI = 0.30-0.60]) were associated with lower odds of successful VATS, while rib fractures (OR=1.29 [95% CI=1.01-1.66]) were associated with higher odds of success of the initial operative plan. Among 3486 patients initially managed with thoracotomy after drainage with tube thoracostomy, 3118 (89.4%) were successful, while 11% (n = 368) required reoperation. Multivariable analysis revealed that major injury (OR = 0.68 [95% CI = 0.50-0.92]), blunt mechanism (OR = 0.63 [95% CI = 0.50-0.78]), and diaphragmatic injury (OR = 0.67, 95% CI = 0.53-0.84]) were associated with lower odds of successful thoracotomy as the initial operative plan.
More severe injuries and diaphragmatic injuries have lower odds of successful of VATS or thoracotomy as the initial operative management strategy among patients with traumatic hemothorax. Rib fractures may be associated with higher odds of success of VATS as the initial management strategy.
很少有研究确定与创伤性血胸患者成功进行电视辅助胸腔镜手术（VATS）或开胸手术作为初始手术策略相关的因素。
我们使用2008年至2017年的TQP数据库进行了一项探索性分析。我们确定了所有年龄在18至89岁之间、患有创伤性血胸且在入院后最初24小时内仅接受胸腔闭式引流治疗、随后接受VATS或开胸手术的患者。采用逻辑回归分析来确定与成功进行VATS（无中转或再次手术）或开胸手术（无再次手术）作为初始手术策略相关的因素。
在2052例胸腔闭式引流后最初接受VATS治疗的患者中，1710例（83%）成功，263例（13%）中转开胸手术，79例（4%）需要再次手术。多变量分析显示，格拉斯哥昏迷评分（GCS）低（比值比[OR]=0.96[95%置信区间（CI）=0.94-0.99]）、严重损伤（OR=0.69[95%CI=0.53-0.90]）和膈肌损伤（OR=0.42[95%CI=0.30-0.60]）与VATS成功的几率较低相关，而肋骨骨折（OR=1.29[95%CI=1.01-1.66]）与初始手术计划成功的几率较高相关。在3486例胸腔闭式引流后最初接受开胸手术治疗的患者中，3118例（89.4%）成功，11%（n=368）需要再次手术。多变量分析显示，严重损伤（OR=0.68[95%CI=0.50-0.92]）、钝性机制（OR=0.63[95%CI=0.50-0.78]）和膈肌损伤（OR=0.67，95%CI=0.53-0.84]）与开胸手术作为初始手术计划成功的几率较低相关。
在创伤性血胸患者中，更严重的损伤和膈肌损伤作为初始手术管理策略进行VATS或开胸手术成功的几率较低。肋骨骨折可能与VATS作为初始管理策略成功的几率较高相关。
