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首页> 外文期刊>The Annals of Thoracic Surgery: Official Journal of the Society of Thoracic Surgeons and the Southern Thoracic Surgical Association >Utilization of Cardiothoracic Surgeons for Operative Penetrating Thoracic Trauma and Its Impact on Clinical Outcomes
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Utilization of Cardiothoracic Surgeons for Operative Penetrating Thoracic Trauma and Its Impact on Clinical Outcomes

机译：心胸外科医生在手术中穿透胸外伤的疗效及其对临床效果的影响

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DiscussionReferencesLarge series reporting outcomes for penetrating thoracic trauma have identified injury pattern and injury severity scoring as predictors of poor outcome. However, the impact of surgical expertise on patient outcomes has not been previously investigated. We sought to determine how often board-certified cardiothoracic surgeons are utilized for operative thoracic trauma and whether this has an effect on patient outcomes.MethodsA level I trauma center registry was queried between 2003 and 2011. Records of patients undergoing surgery as a result of penetrating thoracic?trauma were?retrospectively reviewed. Patient demographics, injuries, injury severity, utilization of?a cardiothoracic surgical operative consult and outcomes were recorded. Patients operated on by cardiothoracic surgeons were compared with patients operated on by trauma surgeons using stepwise multivariate analyses to determine the factors associated with utilization of cardiothoracic surgeons for operative thoracic trauma and survival.ResultsCardiothoracic surgeons were used in 73.0% of?cases (162 of 222) over the study period. The use of cardiothoracic surgeons increased incrementally both overall (38.5% to 73.9%), and for emergent/urgent cases (31.8% to 73.3%). When comparing patients undergoing operation on an emergent/urgent basis by cardiothoracic versus trauma surgeons, there was no significant difference with regard to demographics, mechanism of injury, injury severity scoring, or surgical morbidity. Stepwise logistic regression showed the presence of a cardiothoracic surgeon to be independently associated with survival (odds ratio 4.70; p?= 0.019).ConclusionsUse of cardiothoracic surgeons for operative thoracic trauma increased over the study period. Outcomes for severely injured patients with elevated chest injury scores or decreased revised trauma scores may be improved with appropriate operative consultation with a board-certified cardiothoracic surgeon.CTSNet classification:5, 11Although chest tube thoracostomy can successfully manage the majority of injuries resulting from penetrating thoracic trauma, 9% to 15% of injuries require operative exploration and account for 20% to 25% of all trauma deaths [
机译：讨论参考文献大量报道的穿透性胸外伤的结局已将损伤模式和损伤严重程度评分确定为预后不良的指标。但是，外科专业知识对患者预后的影响尚未进行过调查。我们试图确定经董事会认证的心胸外科医生多久一次用于手术性胸外伤，以及这是否会对患者的结局产生影响。方法在2003年至2011年期间查询了I级创伤中心注册表。由于有穿透性，接受手术的患者的记录回顾性回顾了胸外伤。记录患者的人口统计资料，受伤情况，损伤严重程度，心胸外科手术咨询的使用情况和结果。使用逐步多变量分析比较心胸外科医生的手术患者和创伤外科医生的手术患者，以确定与心胸外科医生用于手术胸外伤和生存的因素。结果心胸外科医生在73.0％的病例中使用（222例中的162例） ）。整体而言，心胸外科医生的使用量（38.5％至73.9％）以及急诊/急诊病例（31.8％至73.3％）均增加。当比较心胸外科医师和创伤外科医师在急诊/紧急情况下进行手术的患者时，在人口统计学，损伤机制，损伤严重度评分或手术发病率方面无显着差异。逐步logistic回归显示，心胸外科医生的存在与生存独立相关（优势比为4.70; p = 0.019）。结论在研究期间，心胸外科医生对手术性胸外伤的使用增加了。 CTSNet分类：5，11尽管胸管切开术可以成功处理胸腔穿刺导致的大部分损伤，但经董事会认证的心胸外科医师进行适当的手术咨询，可能会改善胸部损伤评分较高或修订后的创伤评分降低的重伤患者的结局。创伤，需要进行手术探查的受伤率为9％至15％，占所有创伤死亡人数的20％至25％[

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