Retrospective comparison of operative technique for chest wall injuries

Abstract text (incl. references and figure legends)

INTRODUCTION: Surgical management of chest wall injuries is a common procedure. However, operative techniques are diverse and no universal guidelines exist for the procedure. There is a lack of studies comparing the outcome with different operative techniques for chest wall surgery. The aim of this study was to compare hospital outcomes regarding length of stay between patients operated for chest wall injuries with either a minimally invasive, muscle sparing method or a conventional method with large incisions and usually thoracotomy.

MATERIAL AND METHODS: A retrospective study was made of all patients ≥18 years operated for chest wall injuries between 2010–2020. Patients were divided into two groups based on the surgery performed: a minimally invasive surgery (M-group) and a conventional surgery (C-group). Data on demographics, trauma, surgery and outcomes were extracted from patient records. Primary outcome was length of stay on mechanical ventilator (MV-LOS). Secondary outcomes were length of stay in intensive care (ICU-LOS) and in hospital (H-LOS), and complications such as reoperation, incidence of empyema, tracheostomy, pneumonia, and mortality.

RESULTS: Of 311 included patients, 220 were in the C-group and 91 in the M-group. The groups had similar demographics and injuries. MV-LOS was 0 (0–65) in the C-group vs 0 (0–34) in the M-group (p<0.001). ICU-LOS was 2 (0-67) in the C-group vs 0 (0-50) in the M-group (p<0.001). H-LOS was 15 (5-113) in the C-group vs 11 (2-60) in the M-group (p<0.001). Tracheostomy was performed in 49 (22.3%) patients in the C-group vs 5 (5.4%) in the M-group (p<0.001). Pneumonia was diagnosed in 71 (32.3%) patients in the C-group vs 15 (16.1%) in the M-group (p=0.004).

CONCLUSIONS: Our study indicates that surgical technique affects clinical outcomes for patients operated for chest wall injuries. A minimally invasive technique was shown to be favorable.

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