Emergency operation for penetrating thoracic non-cardiac injuries: A 10-year review at a major trauma centre in South Africa

Abstract

Background and aims: Penetrating thoracic injury is relatively common and is encountered in most trauma centres in South Africa. This study focuses exclusively on patients who required acute operative intervention following penetrating thoracic trauma for a non-cardiac injury. Methods: A retrospective study was conducted on patients who sustained penetrating thoracic trauma requiring operative intervention over the 10 years from January 2012 to December 2022 at a major trauma centre in South Africa. Results: A total of 2548 patients with penetrating thoracic trauma were reviewed, of which 9% (229/2548) required an emergency operative intervention. Of these 229 patients, 79% (180/229) had a penetrating cardiac injury and 21% (49/229) a penetrating non-cardiac injury. A total of 49 patients were included in the final analysis, comprising 98% (48/49) males with a mean age of 31 years. There were 82% (40/49) stab wounds and 18% (9/49) gunshot wounds. The median injury severity score was 14. The most common indication for surgery was haemodynamic instability in 55% (27/49), drainage of blood into the tube thoracostomy in 14% (7/49), imminent or actual cardiac arrest in 7% (3/49) and computed tomography scan findings in 24% (12/49). The most common injuries were to the thoracic wall arteries (16/49) and the thoracic great vessels (13/49). The overall morbidity rate was 35% (17/49), and the mortality rate was 18% (9/49). Conclusion: Most patients who sustain a penetrating thoracic injury can be treated non-operatively. In a small percentage of patients, an urgent operative exploration is necessary for a non-cardiac injury. Most of the injuries mandating urgent operation are caused by stab wounds, and the most common indication for surgery was haemodynamic instability. Appropriate surgical access is vital in managing these injuries. Surgeons managing these patients must be familiar with these potential injuries to make appropriate surgical decisions.