Impact of deferred surgical intervention on the outcome of external laryngeal trauma

Chien Hung Liao, Jen Fu Huang, Shao Wei Chen, Chih Yuan Fu, Li Ang Lee, Chun Hsiang Ouyang, Shang Yu Wang, I. Ming Kuo, Kuo Chin Yuan, Yu Pao Hsu

Research output: Contribution to journalArticle

Abstract

Background External laryngeal trauma (ELT) can be a fatal injury. Proper management of ELT significantly affects patient survival and quality of life. The optimal timing of surgical intervention is controversial. In this study, we review the incidence, management, and outcome of ELT and attempt to analyze the risk factors and prognosis of this injury. Methods We conducted retrospective review using prospective data collection from patients with ELT in a level I trauma center from May 2008 to May 2013. We retrieved data regarding the severity of ELT, Injury Severity Score (ISS), New Injury Severity Score (NISS), Reverse Trauma Score (RTS), surgical timing, intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), long-term outcome, and mortality. We analyzed the risk of prolonged hospitalization, adverse outcome, and mortality. Results The 48 patients in this cohort had a mean age of 40.8 ± 19.6 years. Twenty-four patients underwent operation within 48 hours, 10 patients underwent operation after 48 hours, and the other 14 patients did not require surgical intervention. A high NISS and the necessity for operation prolonged the ICU LOS and the HLOS. A high ISS and a low RTS predicted mortality. Initial phonatory impairment and the necessity of surgical intervention increased adverse outcomes. Conclusions In conclusion, ELT leads to high mortality and morbidity. The mortality in our series was related to severe associated injuries and to initial physical decompensation. Proper resuscitation and aggressively physiologic compensation were more important in the initial phase. Deferred treatment was acceptable until the patients were ready for operation.

Original languageEnglish
Pages (from-to)477-483
Number of pages7
JournalAnnals of Thoracic Surgery
Volume98
Issue number2
DOIs
Publication statusPublished - Jan 1 2014
Externally publishedYes

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Wounds and Injuries
Length of Stay
Injury Severity Score
Mortality
Intensive Care Units
Trauma Centers
Critical Care
Resuscitation
Hospitalization
Quality of Life
Morbidity
Survival
Incidence

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Liao, C. H., Huang, J. F., Chen, S. W., Fu, C. Y., Lee, L. A., Ouyang, C. H., ... Hsu, Y. P. (2014). Impact of deferred surgical intervention on the outcome of external laryngeal trauma. Annals of Thoracic Surgery, 98(2), 477-483. https://doi.org/10.1016/j.athoracsur.2014.04.079

Impact of deferred surgical intervention on the outcome of external laryngeal trauma. / Liao, Chien Hung; Huang, Jen Fu; Chen, Shao Wei; Fu, Chih Yuan; Lee, Li Ang; Ouyang, Chun Hsiang; Wang, Shang Yu; Kuo, I. Ming; Yuan, Kuo Chin; Hsu, Yu Pao.

In: Annals of Thoracic Surgery, Vol. 98, No. 2, 01.01.2014, p. 477-483.

Research output: Contribution to journalArticle

Liao, CH, Huang, JF, Chen, SW, Fu, CY, Lee, LA, Ouyang, CH, Wang, SY, Kuo, IM, Yuan, KC & Hsu, YP 2014, 'Impact of deferred surgical intervention on the outcome of external laryngeal trauma', Annals of Thoracic Surgery, vol. 98, no. 2, pp. 477-483. https://doi.org/10.1016/j.athoracsur.2014.04.079
Liao, Chien Hung ; Huang, Jen Fu ; Chen, Shao Wei ; Fu, Chih Yuan ; Lee, Li Ang ; Ouyang, Chun Hsiang ; Wang, Shang Yu ; Kuo, I. Ming ; Yuan, Kuo Chin ; Hsu, Yu Pao. / Impact of deferred surgical intervention on the outcome of external laryngeal trauma. In: Annals of Thoracic Surgery. 2014 ; Vol. 98, No. 2. pp. 477-483.
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N2 - Background External laryngeal trauma (ELT) can be a fatal injury. Proper management of ELT significantly affects patient survival and quality of life. The optimal timing of surgical intervention is controversial. In this study, we review the incidence, management, and outcome of ELT and attempt to analyze the risk factors and prognosis of this injury. Methods We conducted retrospective review using prospective data collection from patients with ELT in a level I trauma center from May 2008 to May 2013. We retrieved data regarding the severity of ELT, Injury Severity Score (ISS), New Injury Severity Score (NISS), Reverse Trauma Score (RTS), surgical timing, intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), long-term outcome, and mortality. We analyzed the risk of prolonged hospitalization, adverse outcome, and mortality. Results The 48 patients in this cohort had a mean age of 40.8 ± 19.6 years. Twenty-four patients underwent operation within 48 hours, 10 patients underwent operation after 48 hours, and the other 14 patients did not require surgical intervention. A high NISS and the necessity for operation prolonged the ICU LOS and the HLOS. A high ISS and a low RTS predicted mortality. Initial phonatory impairment and the necessity of surgical intervention increased adverse outcomes. Conclusions In conclusion, ELT leads to high mortality and morbidity. The mortality in our series was related to severe associated injuries and to initial physical decompensation. Proper resuscitation and aggressively physiologic compensation were more important in the initial phase. Deferred treatment was acceptable until the patients were ready for operation.

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