Table 6.
Strategies of thoracic surgical approach and classification of anatomic severity
| Variables | Total (n = 482) | Pri-TC (n = 300) | Pu-TC (n = 182) | p Value |
|---|---|---|---|---|
| Surgical approach, n (%) | ||||
| Left anterolateral* | 349 (79.5) | 203 (75.8) | 146 (85.4) | 0.01 |
| Right anterolateral* | 90 (20.5) | 65 (24.3) | 25 (14.6) | |
| Bilateral anterolateral* | 24 (5.5) | 12 (4.5) | 12 (7.1) | 0.23 |
| Sternotomy | 43 (8.9) | 32 (10.7) | 11 (6.0) | 0.08 |
| Resuscitative thoracotomy | 189 (39.2) | 104 (34.7) | 85 (46.7) | 0.009 |
| Surgical incision conversion | 75 (15.6) | 38 (12.7) | 37 (20.3) | 0.02 |
| Contralateral thoracotomy | 32 (42.7) | 22 (57.9) | 10 (27.0) | 0.004 |
| Clamshell thoracotomy | 33 (44.0) | 11 (28.9) | 22 (59.5) | |
| Trapdoor thoracotomy | 3 (4.0) | 3 (7.9) | 0 (0) | |
| Sternotomy | 7 (9.3) | 2 (5.3) | 4 (13.5) | |
| Cardiac massage | 216 (44.8) | 123 (41.0) | 93 (51.1) | 0.03 |
| Release of tamponade | 81 (16.8) | 37 (12.3) | 44 (24.2) | 0.001 |
| Aortic occlusion | 214 (44.4) | 115 (38.3) | 99 (54.4) | 0.001 |
| Pulmonary hilum clamping | 65 (13.5) | 40 (13.3) | 25 (13.7) | 0.90 |
| Intraoperative hemorrhage, mL median (IQR*) | 2400 (1200–3500) | 2475 (1400–3500) | 2100 (1040–3500) | 0.26 |
| AAST Lung Injury Scale, Grade III-IV | 223 (46.3) | 147 (49.0) | 76 (41.7) | 0.12 |
| AAST Heart Injury Scale, Grade III-IV | 71 (14.7) | 37 (12.3) | 34 (18.7) | 0.42 |
| AAST Vascular Injury Scale, Grade III-IV | 29 (6.0) | 22 (7.3) | 7 (3.8) | 0.16 |
| Damage control in thorax | 99 (20.5) | 70 (23.3) | 29 (15.9) | 0.05 |
Pri-TC Private Trauma Center, Pu-TC Public Trauma Center
*
Denominator = 439 (total thoracotomies), IQR interquartile range