Lung-sparing techniques are associated with improved outcome compared with anatomic resection for severe lung injuries.
BACKGROUND
Pulmonary tractotomy was introduced in 1994 as a novel concept for lung salvage after penetrating wounds. Recently, tractotomy has been suggested to increase morbidity and, thus, its practice has been challenged. The purpose of this study was to compare the morbidity and mortality associated with nonanatomic and anatomic lung resection in the management of severe pulmonary injuries.


METHODS
Using our trauma registry, patients admitted to an urban Level I trauma center during an 11-year period with thoracic injuries requiring thoracotomy and pulmonary operation were identified. A chart review was performed with attention to patient demographics, operative treatment, and outcome. Pulmonary operations performed were classified as either nonanatomic (wedge resection and tractotomy) or anatomic resection (lobectomy and pneumonectomy). Statistical analysis was performed using Student's test, Fisher's exact test, and logistic regression as appropriate.


RESULTS
There were 34 men and 2 women, with a mean age of 29 +/- 2 years. Mechanism of injury was predominantly penetrating, with 26 (72%) gunshot wounds and 8 (22%) stab wounds. Intraoperative blood loss and early red blood cell transfusion requirement were lower in patients undergoing nonanatomic resection (3.85 L vs. 11.90 L and 17.4 U vs. 27.9 U, respectively; p < 0.05). Mortality was 4% in the nonanatomic resection group versus 77% in the anatomic resection group.


CONCLUSIONS
Nonanatomic resection is associated with an improved morbidity and mortality compared with anatomic resection in the management of severe lung injuries. Although not a randomized study, these findings encourage the continued application of lung-sparing procedures when feasible.
D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003120:Colorado / Q000453:epidemiology; D004638:Emergency Treatment / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008499:Medical Records; D017063:Outcome Assessment, Health Care; D013510:Pulmonary Surgical Procedures / Q000379:methods / Q000401:mortality* / Q000592:standards; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D014950:Wounds, Penetrating / Q000401:mortality / Q000473:pathology / Q000601:surgery*