PLANNED AND UNPLANNED REOPERATIONS AFTER THORACOTOMY FOR PENETRATING TRAUMA. LESSONS LEARNED AFTER 15 YEARS. afgm2011@gmail.com

PW05-11

PLANNED AND UNPLANNED REOPERATIONS AFTER THORACOTOMY FOR PENETRATING TRAUMA. LESSONS LEARNED AFTER 15 YEARS.

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Juan Carlos Puyana puyajc@upmc.edu Royal College of Surgeons in Ireland Dublín Ireland

Colombia

Oral or Poster

Specific information regarding reoperation after trauma thoracotomies(TT) is scarce. We analyzed the causes, treatment, and outcomes in patients managed in a high-complexity hospital in an upper-middle-income country, searching for strategies to reduce unplanned thoracotomies(UT) after penetrating chest trauma(PTT)

Patients ≥15 years treated with a TT for PTT between 2006 and 2020 were retrospectively reviewed. Trauma characteristics, surgical treatment, causes of reoperation, and outcomes were registered.

Two-hundred-sixty-two TTs were performed. Sixty-six patients died intraoperatively, remaining 196 cases for analysis. Median age was 26 years, 95.9% were male. Gunshot wounds occurred in 59.6%. Resuscitative thoracotomy was performed in 40 cases(20.1%), aortic occlusion in 55(28.1%), damage control thoracotomy(DCT) in 68(34.7%), and a conventional thoracotomy(CT) in 128. Nine DCT patients died without a reoperation. Seventy-nine subjects(40.3%) were reoperated. Twenty after a CT and 59 after a DCT. Thirty-two emergent UT were performed. Eleven after CT and 21 after a DCT. Nine CTs and 38 DCTs had non-emergent reoperations.Bleeding(9 non-mechanical and 7 mechanical) and 6 missed injuries were the most frequent causes of emergent UT. Reconstruction reoperations included 51 closure of the thoracic incision, unpacking(thoracic wall 51, lung 34, perivascular 17), deferred major lung resections (four lobectomies, three pneumonectomies), and three vascular reconstructions. DCT patients who survived until a scheduled reoperation had a similar mortality to no-DCT(8.5%). Mortality after an emergent (UT) was higuer,(50%).

Technical errors leading to post-op bleeding were the most common cause of UR. Timely bleeding control and a standardized surgical approach should reduce the need for emergent reoperations