TY - JOUR
T1 - Operative Management of Aerodigestive Injuries
T2 - Improved Survival Over two Decades
AU - Walker, Patrick F.
AU - Galvagno, Samuel M.
AU - Sachdeva, Ashutosh
AU - Feliciano, David V.
AU - Scalea, Thomas M.
AU - O’Connor, James V.
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2023/12
Y1 - 2023/12
N2 - Introduction: Non-iatrogenic aerodigestive injuries are infrequent but potentially fatal. We hypothesize that advances in management and adoption of innovative therapies resulted in improved survival. Methods: Trauma registry review at a university Level 1 center from 2000 to 2020 that identified adults with aerodigestive injuries requiring operative or endoluminal intervention. Demographics, injuries, operations, and outcomes were abstracted. Univariate analysis was performed, P <.05 was statistically significant. Results: 95 patients had 105 injuries: 68 tracheal and 37 esophageal (including 10 combined). Mean age 30.9 (± 14), 87.4% male, 82.1% penetrating, and 28.4% with vascular injuries. Median ISS, chest AIS, admission BP, Shock Index, and lactate were 26 (16-34), 4 (3-4), 132 (113-149) mmHg,.8 (.7-1.1), and 3.1 (2.4-5.6) mmol/L, respectively. There were 46 cervical and 22 thoracic airway injuries; 5 patients in extremis required preoperative ECMO. 66 airway injuries were surgically repaired and 2 definitively managed with endobronchial stents. There were 24 cervical, 11 thoracic, 2 abdominal esophageal injuries—all repaired surgically. Combined tracheoesophageal injuries were individually managed and buttressed. 4 airway complications were successfully managed, and 11 esophageal complications managed conservatively, stented, or resected. Mortality was 9.6%, half from intraoperative hemorrhage. Specific mortality: tracheobronchial 8.8%, esophageal 10.8%, and combined 20%. Mortality was significantly associated with higher ISS (P =.01), vascular injury (P =.007), blunt mechanism (P =.01), bronchial injury (P =.01), and years 2000-2010 (P =.03), but not combined tracheobronchial injury. Conclusion: Mortality is associated with several variables, including vascular trauma and years 2000-2010. The use of ECMO and endoluminal stents in highly selected patients and institutional experience may account for 97.8% survival over the past decade.
AB - Introduction: Non-iatrogenic aerodigestive injuries are infrequent but potentially fatal. We hypothesize that advances in management and adoption of innovative therapies resulted in improved survival. Methods: Trauma registry review at a university Level 1 center from 2000 to 2020 that identified adults with aerodigestive injuries requiring operative or endoluminal intervention. Demographics, injuries, operations, and outcomes were abstracted. Univariate analysis was performed, P <.05 was statistically significant. Results: 95 patients had 105 injuries: 68 tracheal and 37 esophageal (including 10 combined). Mean age 30.9 (± 14), 87.4% male, 82.1% penetrating, and 28.4% with vascular injuries. Median ISS, chest AIS, admission BP, Shock Index, and lactate were 26 (16-34), 4 (3-4), 132 (113-149) mmHg,.8 (.7-1.1), and 3.1 (2.4-5.6) mmol/L, respectively. There were 46 cervical and 22 thoracic airway injuries; 5 patients in extremis required preoperative ECMO. 66 airway injuries were surgically repaired and 2 definitively managed with endobronchial stents. There were 24 cervical, 11 thoracic, 2 abdominal esophageal injuries—all repaired surgically. Combined tracheoesophageal injuries were individually managed and buttressed. 4 airway complications were successfully managed, and 11 esophageal complications managed conservatively, stented, or resected. Mortality was 9.6%, half from intraoperative hemorrhage. Specific mortality: tracheobronchial 8.8%, esophageal 10.8%, and combined 20%. Mortality was significantly associated with higher ISS (P =.01), vascular injury (P =.007), blunt mechanism (P =.01), bronchial injury (P =.01), and years 2000-2010 (P =.03), but not combined tracheobronchial injury. Conclusion: Mortality is associated with several variables, including vascular trauma and years 2000-2010. The use of ECMO and endoluminal stents in highly selected patients and institutional experience may account for 97.8% survival over the past decade.
KW - Esophagus/foregut
KW - thoracic surgery
KW - trauma
UR - http://www.scopus.com/inward/record.url?scp=85163047845&partnerID=8YFLogxK
U2 - 10.1177/00031348231180917
DO - 10.1177/00031348231180917
M3 - Article
C2 - 37283249
AN - SCOPUS:85163047845
SN - 0003-1348
VL - 89
SP - 5982
EP - 5987
JO - American Surgeon
JF - American Surgeon
IS - 12
ER -