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Preoperative Physiologic Status Determines Outcome in Non-Emergent Aortic Injury Repair FREE TO VIEW

Jeff M. Apple, MD; Neelan Doolabh, MD; Don Kohan, MD; Brian Eastridge, MD, FACS; Michael Wait, MD, FACS
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UT Southwestern Medical Center, Dallas, TX


Chest. 2003;124(4_MeetingAbstracts):159S. doi:10.1378/chest.124.4_MeetingAbstracts.159S-b
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PURPOSE:  To determine factors which affect outcome of blunt aortic injury repair in the nonemergent setting. Our hypothesis was that outcome after non-emergent aortic injury repair is determined more by preoperative physiologic status than time to repair, associated injuries and delaying factors.

METHODS:  Retrospective review of all aortic injury patients at Parkland Memorial Hospital who arrived to the emergency room with vital signs from 1989-2001 and who underwent non-emergent aortic repair. Preoperative physiologic parameters, including base deficit and p02/FIO2 ratio (PFR), were recorded prior to undergoing operation. The effect of ISS, time from injury to repair, and delaying factors were analyzed. Postoperative morbidity, mortality and ventilator dependence were the major end-points. Statistical analysis was performed using Student’s t test and Chi square analysis.

RESULTS:  We identified 65 patients who underwent attempted non-emergent aortic repair. There were seven deaths (10.8%), five postoperative and two intraoperative. ISS in survivors was 39 +/−10.0 versus 42 +/−13.1 in nonsurvivors (p=.39). PFR in survivors was 429 +/−163.5 versus 197 +/−109.9 in nonsurvivors (p=<.01). Preoperative base deficit in survivors was 2+/−5.1 versus 6 +/− 2.7 in nonsurvivors (p=.05). Eighteen patients met criteria for postoperative ventilator dependence. Preoperative PFR in those patients without postoperative ventilator dependence was 451+/−183.5 versus 335 +/−107.8 in those with postoperative ventilator dependence (p=.01). There was no significant difference in mortality in the early and late repair groups or in thos patients with and without delaying factors prior to operation.CONCLUSIONS: Preoperative physiologic status is more important in determining outcome than injury severity score, delaying factors and timing of repair. Low preoperative PFR may predict postoperative ventilatory dependence.

CLINICAL IMPLICATIONS:  Preoperative correction of base deficit and PFR may assist in optimizing outcomes in patients undergoing non-emergent aortic repair and help determine proper timing of thoracotomy.

DISCLOSURE:  J.M. Apple, None.

Wednesday, October 29, 2003

12:30 PM - 2:00 PM




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