Penetrating thoraco-abdominal injuries: the Auckland City Hospital experience

Penetrating injuries to the thoraco-abdominal region are rare in New Zealand. Most are low velocity wounds and are managed by general surgeons. However, injuries to major vascular structures and the heart are best managed by a multidisciplinary approach.

In Auckland, the cardiothoracic service was located at a different site to Auckland City Hospital (ACH) prior to December 2003. In December 2003, the cardiothoracic unit relocated to ACH. To determine what changes in practice eventuated from having an on-site cardiothoracic service, we reviewed all patients who had thoraco-abdominal injuries between 1998 and 2003 and subsequently.

There were 60 patients with thoraco-abdominal penetrating injury between December 1998 and December 2003 (Group A), and 42 patients between December 2003 and September 2008 (Group B). Twelve patients in Group A and 13 patients in Group B underwent thoracotomy. Twenty-two patients in Group A and 27 patients in Group B required operations other than thoracotomy for their injuries. There was a trend of increasing involvement of cardiothoracic surgeons post-2003, in those patients undergoing thoracotomy, but not in the non-thoracotomy patients. There were six re-explorations in thoracotomy patients in the pre-2003 era: done for bleeding (3), air leak following lung resection (1) and missed cardiac injuries (2), but none in post-2003 period. There was one death in Group A but none in Group B.

Our study demonstrates that a properly trained general surgeon can make appropriate decisions and perform life-saving surgery in thoraco-abdominal stab wounds. However, the on-site availability of cardiothoracic surgeons leads to surgery with fewer complications.