title: Societal costs of inappropriate emergency department thoracotomy.
abstract: BACKGROUND
  Emergency department (ED) thoracotomy can be lifesaving. It can also lead to resource waste and exposure to blood-borne infections. We investigated the frequency with which ED thoracotomy was performed for inappropriate indications and the resulting societal costs.
  
  
  METHODS
  This retrospective cohort study examined all trauma patients admitted directly from the scene of injury from 1992 to 2009 who underwent ED thoracotomy. The main outcomes included inappropriate ED thoracotomy. Secondary outcomes included resource use and societal costs for performing ED thoracotomy for improper indications. Specifically, we analyzed for operating room use, blood transfusions, ICU and hospital stay, needlestick injuries, survivor rate, and neurological outcomes in this group.
  
  
  RESULTS
  One hundred and twenty-three patients underwent ED thoracotomy during the study period. Of those, 63 (51%) were considered inappropriate. In this group, we observed no survivors, none became organ donors, 3 cases of needlestick injuries to health care providers occurred, and 335 U of blood products were used in their care. Also, 4 patients of 63 survived to the operating room and required a total of 6 separate operating room visits. Three of these patients had an ICU stay of 1 day and 1 died on day 5.
  
  
  CONCLUSIONS
  ED thoracotomy should be reserved for potentially salvageable patients, but discouraged for other indications. From the societal point of view, inappropriate use of the procedure resulted in substantial costs and waste of resources, exposure of health care providers to possible blood-borne infections, and offered no survival benefit.
authors: Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. edward.passos@sunnybrook.ca
authors: Edward M
authors: EM
authors: Passos
authors: Paul T
authors: PT
authors: Engels
authors: Jeffrey D
authors: JD
authors: Doyle
authors: Andrew
authors: A
authors: Beckett
authors: Bartolomeu
authors: B
authors: Nascimento
authors: Sandro B
authors: SB
authors: Rizoli
authors: Homer C
authors: HC
authors: Tien
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017281:Cost of Illness; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013908:Thoracotomy / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures; D055815:Young Adult