Right-Sided Versus Left-Sided Pneumonectomy in Trauma: A Nationwide Analysis

Area of Science:

• Trauma Surgery
• Thoracic Surgery
• Critical Care Medicine

Background:

• Pneumonectomy (lung removal) is a rare but high-risk trauma procedure.
• Existing research suggests right-sided pneumonectomy may increase mortality in cancer patients, but data in trauma is limited.
• Understanding laterality's impact on outcomes is crucial for trauma care.

Purpose of the Study:

• To compare patient outcomes between right-sided and left-sided pneumonectomy following trauma.
• To investigate if the side of pneumonectomy influences in-hospital mortality in trauma patients.

Main Methods:

• Retrospective cohort study utilizing the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database (2016-2022).
• Included trauma patients aged 16 years or older who underwent pneumonectomy, stratified by laterality.
• Compared baseline characteristics, injury profiles, and clinical outcomes; multivariable analysis assessed mortality risk.

Main Results:

• 301 patients underwent pneumonectomy; 45.5% had right-sided procedures.
• Extracorporeal membrane oxygenation (ECMO) was more frequent in right-sided pneumonectomy (8.8% vs 2.4%, P=0.015).
• In-hospital mortality was similar: 54.0% for right vs 48.2% for left (P=0.313); right-sided pneumonectomy was not linked to increased mortality (aOR 1.137, P=0.662).

Conclusions:

• The laterality of pneumonectomy in trauma patients is not associated with increased in-hospital mortality.
• Findings suggest surgeons can proceed with pneumonectomy based on injury, not side.
• Further research is needed on ECMO's role in trauma patients requiring pneumonectomy.