Eleven-Year Experience Treating Blunt Thoracic Aortic Injury at a Tertiary Referral Center
| Autor: | Zainab Faiza, Lawrence S. Lee, Timothy J. Hartman, Chelsea M. McCurdy, Lava Timsina, Niharika Namburi, Peter C. Jenkins, Joel S. Corvera |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Indiana medicine.medical_specialty Thoracic Injuries Aortic injury 030204 cardiovascular system & hematology Wounds Nonpenetrating Tertiary Care Centers 03 medical and health sciences Injury Severity Score 0302 clinical medicine Blunt Humans Medicine Hospital Mortality Retrospective Studies Surgical repair Abbreviated Injury Scale business.industry Retrospective cohort study Middle Aged Thoracic Surgical Procedures Surgery Treatment Outcome 030228 respiratory system Cohort Referral center Female Cardiology and Cardiovascular Medicine business Follow-Up Studies Forecasting |
| Zdroj: | The Annals of Thoracic Surgery. 110:524-530 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2019.11.046 |
| Popis: | Background Blunt thoracic aortic injury treatment has evolved over the past decade particularly with respect to endovascular intervention options. We investigated the trends in blunt thoracic aortic injury management and outcomes over an 11-year span at the sole tertiary referral center in our state. Methods We retrospectively reviewed all patients who presented to our institution with blunt traumatic aortic injury between 2007 and 2017. Baseline demographics including aortic injury grade, injury severity score, and abbreviated injury scale were collected. Outcomes were compared by type and timing of treatment, which included either nonoperative management, endovascular repair, or open surgical repair. Bivariate and multivariable analyses were performed to examine treatment group differences and factors associated with 30-day mortality. Results In total, 229 patients were reviewed. The distribution of injury severity was grade 1 (30%), grade 2 (8%), grade 3 (30%), and grade 4 (31%). Overall, 27% of patients underwent endovascular repair, 29% open surgery, and 44% definitive nonoperative management. Over the study period, there was a dramatic decline in open surgery and a corresponding rise in endovascular treatment. Thirty-day mortality for the entire cohort was 22%. Mortality by treatment subgroup was 30% for nonoperative management, 8.2% for endovascular treatment, and 21% for open surgery. Delaying endovascular or open surgical treatment by at least 24 hours after admission was associated with significantly improved 30-day survival. Conclusions Procedural intervention, whether endovascular or surgical, is associated with improved mortality compared with nonoperative treatment. Delayed intervention, particularly in the case of high-grade injuries, may allow for initial patient stabilization and improved outcomes. |
| Databáze: | OpenAIRE |
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