Video-Assisted Thoracoscopic Surgery for Posttraumatic Hemothorax in the Very Elderly

Abstract

Objective Thoracic injury is a life-threatening condition with advanced age being an independent risk factor for both higher morbidity and mortality. Furthermore, elderly patients often have severe comorbidity and in case of chest trauma with rib fractures and hemothorax, their clinical condition is likely to deteriorate fast. Aim of this study is to investigate the feasibility and results of video-assisted thoracoscopy for the treatment of posttraumatic hemothorax in very elderly patients of 80 years or more.

Methods The outcomes of 60 consecutive patients who received video-assisted thoracoscopic surgery for posttraumatic hemothorax in a German tertiary referral hospital between 2006 and 2010 were reviewed in a retrospective case study. Patients older than 80 years were identified.

Results There were 39 male and 21 female patients. The median age was 63.2 years. The in-hospital-mortality was 1.7% (1/60). Fifteen of the 60 patients were 80 years or older (80–91). Main reason for hemothorax was blunt chest trauma. Altogether 23 patients had fractures of three or more ribs including six octogenarians. Elderly patients suffered from preexisting cardiopulmonary disease and were often referred to the thoracic surgeon with considerable delay. Video-assisted thoracoscopic surgery was feasible and all octogenarian patients finally recovered well without in-hospital-mortality.

Conclusions Video-assisted thoracoscopic surgery for treatment of posttraumatic hemothorax shows excellent results in very elderly patients of 80 years or more. Despite severe comorbidity and often delayed surgery all patients recovered. We therefore conclude that advanced age is no contraindication for surgical management of posttraumatic hemothorax by means of video-assisted thoracoscopy.

Keywords

geriatric (includes elderly) - lung - benign or congenital lesions - minimally invasive surgery (includes port access - minithoracotomy) - thoracoscopy/VATS

• References

• 1 Hanafi M, Al-Sarraf N, Sharaf H, Abdelaziz A. Pattern and presentation of blunt chest trauma among different age groups. Asian Cardiovasc Thorac Ann 2011; 19 (1) 48-51
• 2 Müller C, Hatz R. Strategies in the diagnosis and treatment of chest trauma. Viszeralchirurgie 2005; 40: 368-373
• 3 Elmistekawy EM, Hammad AA. Isolated rib fractures in geriatric patients. Ann Thorac Med 2007; 2 (4) 166-168
• 4 Bergeron E, Lavoie A, Clas D , et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma 2003; 54 (3) 478-485
• 5 Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury 2011 ; January 20 (Epub ahead of print]
• 6 Shorr RM, Rodriguez A, Indeck MC, Crittenden MD, Hartunian S, Cowley RA. Blunt chest trauma in the elderly. J Trauma 1989; 29 (2) 234-237
• 7 Alexander JQ, Gutierrez CJ, Mariano MC , et al. Blunt chest trauma in the elderly patient: how cardiopulmonary disease affects outcome. Am Surg 2000; 66 (9) 855-857
• 8 Eren S, Esme H, Sehitogullari A, Durkan A. The risk factors and management of posttraumatic empyema in trauma patients. Injury 2008; 39 (1) 44-49
• 9 Holcomb JB, McMullin NR, Kozar RA, Lygas MH, Moore FA. Morbidity from rib fractures increases after age 45. J Am Coll Surg 2003; 196 (4) 549-555
• 10 Abolhoda A, Livingston DH, Donahoo JS, Allen K. Diagnostic and therapeutic video assisted thoracic surgery (VATS) following chest trauma. Eur J Cardiothorac Surg 1997; 12 (3) 356-360
• 11 Meyer DM, Jessen ME, Wait MA, Estrera AS. Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial. Ann Thorac Surg 1997; 64 (5) 1396-1400, discussion 1400–1401
• 12 Navsaria PH, Vogel RJ, Nicol AJ. Thoracoscopic evacuation of retained posttraumatic hemothorax. Ann Thorac Surg 2004; 78 (1) 282-285, discussion 285–286
• 13 Potaris K, Mihos P, Gakidis I. Role of video-assisted thoracic surgery in the evaluation and management of thoracic injuries. Interact Cardiovasc Thorac Surg 2005; 4 (4) 292-294
• 14 Fabbrucci P, Nocentini L, Secci S , et al. Video-assisted thoracoscopy in the early diagnosis and management of post-traumatic pneumothorax and hemothorax. Surg Endosc 2008; 22 (5) 1227-1231
• 15 Helling TS, Gyles III NR, Eisenstein CL, Soracco CA. Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracostomy. J Trauma 1989; 29 (10) 1367-1370
• 16 Deneuville M. Morbidity of percutaneous tube thoracostomy in trauma patients. Eur J Cardiothorac Surg 2002; 22 (5) 673-678
• 17 Queirós J, Cabrita A, Maximino J, Lobato L, Silva M, Xavier E. Central catheters for hemodialysis: a six month experience of 103 catheters. Nephrologie 1994; 15 (2) 113-115
• 18 Vanherweghem JL, Cabolet P, Dhaene M , et al. Complications related to subclavian catheters for hemodialysis. Report and review. Am J Nephrol 1986; 6 (5) 339-345
• 19 Ruesch S, Walder B, Tramèr MR. Complications of central venous catheters: internal jugular versus subclavian access—a systematic review. Crit Care Med 2002; 30 (2) 454-460
• 20 Yacovone ML, Kartan R, Bautista M. Intercostal artery laceration following thoracentesis. Respir Care 2010; 55 (11) 1495-1498