Nikolay Bugaev1, Janis L Breeze2, Alyssa M Tutunjian3, Horacio M Hojman4, Eric J Mahoney5, Benjamin P Johnson6, Sandra S Arabian7. 1. (nbugaev@tuftsmedicalcenter.org), is associate director of trauma, Division of Trauma & Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, Assistant Professor of Surgery. 2. (jbreeze@tuftsmedicalcenter.org) is associate director and an epidemiologist, Tufts Clinical and Translational Science Institute, Tufts University, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center. 3. (alyssa.tutunjian@tufts.edu) is a medical student at Tufts University School of Medicine. 4. (hhojman@tuftsmedicalcenter.org) is trauma medical director, Division of Trauma & Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, Assistant Professor of Surgery. 5. (emahoney1@tuftsmedicalcenter.org) is attending surgeon, Division of Trauma & Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, Assistant Professor of Surgery. 6. (bjohnson5@tuftsmedicalcenter.org) is attending surgeon, Division of Trauma & Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, Assistant Professor of Surgery. 7. (sarabian@tuftsmedicalcenter.org) is trauma program manager, Division of Trauma & Acute Care Surgery, Tufts Medical Center.
Abstract
Background: Comparative morbidity after either sternotomy or non-resuscitative thoracotomy in penetrating cardiac injuries (PCI) is unknown. Methods: Retrospective review of adults with PCI who underwent either sternotomy or non-resuscitative thoracotomy using the National Trauma Data Bank 2007-2015. Since there is no unique International Classification of Diseases Procedure Coding System (ICD-PCS) codes assigned for resuscitative vs. non-resuscitative thoracotomy, and both procedures were coded as "thoracotomy", propensity score (PS) methods were applied to avoid inclusion of resuscitative thoracotomy. Results: Despite well PS matching on injury severity score the non-thoracotomy group compared to the sternotomy group had a significantly increased risk of mortality (30 percent vs 8 percent, p<0.0001). The morbidity differed as well-25 percent vs. 12 percent, p=0.0007. Conclusions: The differences in mortality in PCI patients who underwent non-resuscitative thoracotomy vs. sternotomy may be biased by unintentional inclusion of resuscitative thoracotomy. To accurately capture thoracotomy type, separate unique resuscitative and non-resuscitative thoracotomy procedure codes should be created in future revisions of the ICD PCS.
Background: Comparative morbidity after either sternotomy or non-resuscitative thoracotomy in penetrating cardiac injuries (PCI) is unknown. Methods: Retrospective review of adults with PCI who underwent either sternotomy or non-resuscitative thoracotomy using the National Trauma Data Bank 2007-2015. Since there is no unique International Classification of Diseases Procedure Coding System (ICD-PCS) codes assigned for resuscitative vs. non-resuscitative thoracotomy, and both procedures were coded as "thoracotomy", propensity score (PS) methods were applied to avoid inclusion of resuscitative thoracotomy. Results: Despite well PS matching on injury severity score the non-thoracotomy group compared to the sternotomy group had a significantly increased risk of mortality (30 percent vs 8 percent, p<0.0001). The morbidity differed as well-25 percent vs. 12 percent, p=0.0007. Conclusions: The differences in mortality in PCI patients who underwent non-resuscitative thoracotomy vs. sternotomy may be biased by unintentional inclusion of resuscitative thoracotomy. To accurately capture thoracotomy type, separate unique resuscitative and non-resuscitative thoracotomy procedure codes should be created in future revisions of the ICD PCS.
Authors: Mark J Seamon; Elliott R Haut; Kyle Van Arendonk; Ronald R Barbosa; William C Chiu; Christopher J Dente; Nicole Fox; Randeep S Jawa; Kosar Khwaja; J Kayle Lee; Louis J Magnotti; Julie A Mayglothling; Amy A McDonald; Susan Rowell; Kathleen B To; Yngve Falck-Ytter; Peter Rhee Journal: J Trauma Acute Care Surg Date: 2015-07 Impact factor: 3.313