Yusuf Kilic (Magdeburg / DE), Anton Popov (Magdeburg / DE), Bastian Fakundiny (Magdeburg / DE), Henning Busk (Magdeburg / DE), Thorsten Walles (Magdeburg / DE)
Abstract text (incl. references and figure legends)
Introduction
Thoracic trauma is a common injury with high morbidity and mortality. Thoracotomy (THK) is recommended for the surgical treatment of acute intrathoracic injuries. Compared to minimally invasive thoracic surgical procedures (VATS), this represents a significant additional burden for the patient. At our institution, VATS operations are carried out as part of the interdisciplinary care of trauma patients at a supra-regional trauma center.
Material & Methods
Monocentric retrospective cohort analysis of all patients who underwent surgery for acute intrathoracic bleeding between 01/2017 and 12/2021. Patients with thoracic trauma and previous thoracic interventions were included. Patient characteristics, type of injury (trauma vs. post-interventional, lateral location, ASA score), surgical main and secondary diagnoses, intra- and postoperative course were analyzed including complications.
Results
93 patients (71% male, 66±18 years, ASA 3.38±0.85) underwent surgery for acute hemothorax: VATS n=60; THK n=33. Of these, 43/93 (46.2%) patients had acute chest trauma. 17% of VATS patients and 52% of THK patients were hemodynamically unstable at the begin of surgery. 10 VATS patients (17%) had to be converted to the open surgical procedure. The operating times (74±48 vs 125±69 minutes, p<.001) and intraoperative bleeding amounts (319±506 vs 728±871 ml, p=0.008) differed significantly in the two treatment groups. 43% of VATS patients and 76% of THK patients had postoperative complications Mortality in the VATS group was significantly lower (7 vs 24%, p=0.028).
Conclusions
We can show that VATS is possible in more than 2/3 of the trauma patients. In the acute surgical setting, less than 20% of VATS interventions have to be stopped and continued as open surgery because of un-expected intraoperative findings. VATS operations can also be carried out safely in haemodynamically unstable patients.
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