PULMONARY RESECTION FOR LUNG TRAUMA

Background. Pulmonary resection is rarely required for trauma, and its mortality is reportedly high. Methods. A 10-year retrospective review of pulmonary resections for trauma was done. Results. Of 2,455 patien ts with chest trauma, 183 (7.4%) underwent thoracotomy and 32 (1.3%) r equired pulmonary resection. Mean age was 28.4 years and mean injury s everity score was 24.5. Mechanism of injury was stab wound in 14 patie nts, gunshot wound in 6, and blunt trauma in 12. Blunt trauma patients had a higher injury severity score (29.6) than penetrating trauma pat ients (21.4), but this was not significant (p < 0.07). Indications for thoracotomy were hemorrhage in 24 patients, airway disruption in 4, a nd other indications in 4. Operations consisted of wedge resection (19 patients), lobectomy (9), and pneumonectomy (4). Four (12.5%) patient s (pneumonectomy, 2; lobectomy, 1; wedge, 1) died. Mortality for pneum onectomy was 50%, but this was not significantly higher than for lesse r resections. Blunt trauma had a higher mortality (33%) than penetrati ng trauma (0%) (p < 0.02). Nonsurvivors had higher injury severity sco res (44.2) than survivors (21.6) (p < 0.001). Conclusions. Pulmonary r esection is infrequently required for lung injury. Overall mortality i s lower than previously reported, but pneumonectomy has a high mortali ty. Blunt trauma has a higher mortality than penetrating trauma. Injur y severity scores are higher for nonsurvivors than survivors; this sho ws the importance of associated injuries on outcome. (C) 1997 by The S ociety of Thoracic Surgeons.