Damage control thoracotomy trends, techniques, and outcomes: An EAST multicenter trial

Anthony D. Douglas; Teddy Puzio; Partick Murphy; Jeffry Nahmias; Nikolay Bugaev; Haytham Kaafarani; Leah Tatebe; Bryce Robinson; Matthew Carrick; Jordan Finch; Harrison Smith; Leah Hoefer; Robert Keskey; Andrew Snyder; Madison J. Leclair; David Turay; Gerald Wang; Gweniviere Capron; Dillon Cheung; Atli Valgardsson; Brittany Bankhead; Anna Liveris; John Taylor; Dominic Cromer; Anna Goldenberg-Sandau; Taylor Powers; Asanthi Ratnasekera; Sirivan Seng; Juan Figueroa; Francesk Mulita; Ioannis Panagiotopoulos; Juan Ramos; Liz Villalobos; Nicole Frederick; Lauren Favors; Robert Maxwell; Chance Spalding; Anna Kurian; Kimberly Sperwer; Lara Senekijan; Anthony Gebran; Rachel Burke; Satya Dalavayi; Gillian Hoshal; Christine Cocanour; Grace Chang; Ashley Meagher

doi:10.1097/TA.0000000000004492

Damage control thoracotomy trends, techniques, and outcomes: An EAST multicenter trial

Anthony D. Douglas
, Teddy Puzio
, Partick Murphy
, Jeffry Nahmias
, Nikolay Bugaev
, Haytham Kaafarani
, Leah Tatebe
, Bryce Robinson
, Matthew Carrick
, Jordan Finch
, Harrison Smith
, Leah Hoefer
, Robert Keskey
, Andrew Snyder
, Madison J. Leclair
, David Turay
, Gerald Wang
, Gweniviere Capron
, Dillon Cheung
, Atli Valgardsson

Brittany Bankhead, Anna Liveris, John Taylor, Dominic Cromer, Anna Goldenberg-Sandau, Taylor Powers, Asanthi Ratnasekera, Sirivan Seng, Juan Figueroa, Francesk Mulita, Ioannis Panagiotopoulos, Juan Ramos, Liz Villalobos, Nicole Frederick, Lauren Favors, Robert Maxwell, Chance Spalding, Anna Kurian, Kimberly Sperwer, Lara Senekijan, Anthony Gebran, Rachel Burke, Satya Dalavayi, Gillian Hoshal, Christine Cocanour, Grace Chang, Ashley Meagher

CMSRU Faculty Affairs

Rowan University

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND Damage-control thoracotomy (DCT) lacks evidence regarding frequency of use, optimal technique, and outcomes. This Eastern Association for the Surgery of Trauma multicenter trial aimed to examine DCT usage over the last decade, evaluate types of temporary closure, and assess associated outcomes. METHODS An international retrospective cohort study of thoracotomies from 2008 to 2020 at 25 centers was performed. Patients age 16 years or older undergoing thoracotomy within 24 hours of admission who survived to intensive care unit (ICU) admission were included. Mixed logistic regression was used to assess complications associated with closure type, trends in DCT utilization, and mortality. Competing risk regression model was used to determine trends in ICU-free days for DCT over time. RESULTS Nine hundred twenty-two thoracotomy operations were performed, of those 402 (44%) were DCT. Most injuries were penetrating (n = 609, 66%) and the most common mechanism was gunshot wound. Damage-control thoracotomy patients were significantly more injured and ill on presentation. Fifty-four percent of DCT began in the emergency department. Most common temporary closure types included skin only (n = 103, 25%), commercial vacuum device (n = 123,30%), and adhesive dressing (n = 129, 32%). Frequent complications following DCT were pneumonia (n = 57, 14%), acute renal failure (n = 53,13%), and sepsis (n = 41, 10%). Mortality rate in the DCT group was 61%, versus 17% for definitive thoracotomy (n < 0.001). Utilization of DCT has increased in a linear fashion during the study period, as well as ICU-free days out of 30 (odds ratio, 1.66; 95% confidence interval, 1.18-2.33); however, mortality has not changed over time (odds ratio, 0.61; 95% confidence interval, 0.22-1.98). After mixed logistic regression, there was no difference in complications based on closure type. CONCLUSION The use of DCT is increasing over time with improved ICU-free days, but without improved mortality. Mechanism of temporary closure should be determined based on operator's experience and institutional resources.

Original language	English (US)
Pages (from-to)	460-467
Number of pages	8
Journal	Journal of Trauma and Acute Care Surgery
Volume	99
Issue number	3
DOIs	https://doi.org/10.1097/TA.0000000000004492
State	Published - Sep 1 2025

ASJC Scopus subject areas

Surgery
Critical Care and Intensive Care Medicine

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10.1097/TA.0000000000004492

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Douglas, A. D., Puzio, T., Murphy, P., Nahmias, J., Bugaev, N., Kaafarani, H., Tatebe, L., Robinson, B., Carrick, M., Finch, J., Smith, H., Hoefer, L., Keskey, R., Snyder, A., Leclair, M. J., Turay, D., Wang, G., Capron, G., Cheung, D., ... Meagher, A. (2025). Damage control thoracotomy trends, techniques, and outcomes: An EAST multicenter trial. Journal of Trauma and Acute Care Surgery, 99(3), 460-467. https://doi.org/10.1097/TA.0000000000004492

@article{b1856ce43a6f4c10b8a0b105778cc7a8,

title = "Damage control thoracotomy trends, techniques, and outcomes: An EAST multicenter trial",

abstract = "BACKGROUND Damage-control thoracotomy (DCT) lacks evidence regarding frequency of use, optimal technique, and outcomes. This Eastern Association for the Surgery of Trauma multicenter trial aimed to examine DCT usage over the last decade, evaluate types of temporary closure, and assess associated outcomes. METHODS An international retrospective cohort study of thoracotomies from 2008 to 2020 at 25 centers was performed. Patients age 16 years or older undergoing thoracotomy within 24 hours of admission who survived to intensive care unit (ICU) admission were included. Mixed logistic regression was used to assess complications associated with closure type, trends in DCT utilization, and mortality. Competing risk regression model was used to determine trends in ICU-free days for DCT over time. RESULTS Nine hundred twenty-two thoracotomy operations were performed, of those 402 (44\%) were DCT. Most injuries were penetrating (n = 609, 66\%) and the most common mechanism was gunshot wound. Damage-control thoracotomy patients were significantly more injured and ill on presentation. Fifty-four percent of DCT began in the emergency department. Most common temporary closure types included skin only (n = 103, 25\%), commercial vacuum device (n = 123,30\%), and adhesive dressing (n = 129, 32\%). Frequent complications following DCT were pneumonia (n = 57, 14\%), acute renal failure (n = 53,13\%), and sepsis (n = 41, 10\%). Mortality rate in the DCT group was 61\%, versus 17\% for definitive thoracotomy (n < 0.001). Utilization of DCT has increased in a linear fashion during the study period, as well as ICU-free days out of 30 (odds ratio, 1.66; 95\% confidence interval, 1.18-2.33); however, mortality has not changed over time (odds ratio, 0.61; 95\% confidence interval, 0.22-1.98). After mixed logistic regression, there was no difference in complications based on closure type. CONCLUSION The use of DCT is increasing over time with improved ICU-free days, but without improved mortality. Mechanism of temporary closure should be determined based on operator's experience and institutional resources.",

author = "Douglas, \{Anthony D.\} and Teddy Puzio and Partick Murphy and Jeffry Nahmias and Nikolay Bugaev and Haytham Kaafarani and Leah Tatebe and Bryce Robinson and Matthew Carrick and Jordan Finch and Harrison Smith and Leah Hoefer and Robert Keskey and Andrew Snyder and Leclair, \{Madison J.\} and David Turay and Gerald Wang and Gweniviere Capron and Dillon Cheung and Atli Valgardsson and Brittany Bankhead and Anna Liveris and John Taylor and Dominic Cromer and Anna Goldenberg-Sandau and Taylor Powers and Asanthi Ratnasekera and Sirivan Seng and Juan Figueroa and Francesk Mulita and Ioannis Panagiotopoulos and Juan Ramos and Liz Villalobos and Nicole Frederick and Lauren Favors and Robert Maxwell and Chance Spalding and Anna Kurian and Kimberly Sperwer and Lara Senekijan and Anthony Gebran and Rachel Burke and Satya Dalavayi and Gillian Hoshal and Christine Cocanour and Grace Chang and Ashley Meagher",

year = "2025",

month = sep,

day = "1",

doi = "10.1097/TA.0000000000004492",

language = "English (US)",

volume = "99",

pages = "460--467",

journal = "Journal of Trauma and Acute Care Surgery",

issn = "2163-0755",

publisher = "Lippincott Williams and Wilkins",

number = "3",

}

Douglas, AD, Puzio, T, Murphy, P, Nahmias, J, Bugaev, N, Kaafarani, H, Tatebe, L, Robinson, B, Carrick, M, Finch, J, Smith, H, Hoefer, L, Keskey, R, Snyder, A, Leclair, MJ, Turay, D, Wang, G, Capron, G, Cheung, D, Valgardsson, A, Bankhead, B, Liveris, A, Taylor, J, Cromer, D, Goldenberg-Sandau, A, Powers, T, Ratnasekera, A, Seng, S, Figueroa, J, Mulita, F, Panagiotopoulos, I, Ramos, J, Villalobos, L, Frederick, N, Favors, L, Maxwell, R, Spalding, C, Kurian, A, Sperwer, K, Senekijan, L, Gebran, A, Burke, R, Dalavayi, S, Hoshal, G, Cocanour, C, Chang, G & Meagher, A 2025, 'Damage control thoracotomy trends, techniques, and outcomes: An EAST multicenter trial', Journal of Trauma and Acute Care Surgery, vol. 99, no. 3, pp. 460-467. https://doi.org/10.1097/TA.0000000000004492

TY - JOUR

T1 - Damage control thoracotomy trends, techniques, and outcomes

T2 - An EAST multicenter trial

AU - Douglas, Anthony D.

AU - Puzio, Teddy

AU - Murphy, Partick

AU - Nahmias, Jeffry

AU - Bugaev, Nikolay

AU - Kaafarani, Haytham

AU - Tatebe, Leah

AU - Robinson, Bryce

AU - Carrick, Matthew

AU - Finch, Jordan

AU - Smith, Harrison

AU - Hoefer, Leah

AU - Keskey, Robert

AU - Snyder, Andrew

AU - Leclair, Madison J.

AU - Turay, David

AU - Wang, Gerald

AU - Capron, Gweniviere

AU - Cheung, Dillon

AU - Valgardsson, Atli

AU - Bankhead, Brittany

AU - Liveris, Anna

AU - Taylor, John

AU - Cromer, Dominic

AU - Goldenberg-Sandau, Anna

AU - Powers, Taylor

AU - Ratnasekera, Asanthi

AU - Seng, Sirivan

AU - Figueroa, Juan

AU - Mulita, Francesk

AU - Panagiotopoulos, Ioannis

AU - Ramos, Juan

AU - Villalobos, Liz

AU - Frederick, Nicole

AU - Favors, Lauren

AU - Maxwell, Robert

AU - Spalding, Chance

AU - Kurian, Anna

AU - Sperwer, Kimberly

AU - Senekijan, Lara

AU - Gebran, Anthony

AU - Burke, Rachel

AU - Dalavayi, Satya

AU - Hoshal, Gillian

AU - Cocanour, Christine

AU - Chang, Grace

AU - Meagher, Ashley

PY - 2025/9/1

Y1 - 2025/9/1

N2 - BACKGROUND Damage-control thoracotomy (DCT) lacks evidence regarding frequency of use, optimal technique, and outcomes. This Eastern Association for the Surgery of Trauma multicenter trial aimed to examine DCT usage over the last decade, evaluate types of temporary closure, and assess associated outcomes. METHODS An international retrospective cohort study of thoracotomies from 2008 to 2020 at 25 centers was performed. Patients age 16 years or older undergoing thoracotomy within 24 hours of admission who survived to intensive care unit (ICU) admission were included. Mixed logistic regression was used to assess complications associated with closure type, trends in DCT utilization, and mortality. Competing risk regression model was used to determine trends in ICU-free days for DCT over time. RESULTS Nine hundred twenty-two thoracotomy operations were performed, of those 402 (44%) were DCT. Most injuries were penetrating (n = 609, 66%) and the most common mechanism was gunshot wound. Damage-control thoracotomy patients were significantly more injured and ill on presentation. Fifty-four percent of DCT began in the emergency department. Most common temporary closure types included skin only (n = 103, 25%), commercial vacuum device (n = 123,30%), and adhesive dressing (n = 129, 32%). Frequent complications following DCT were pneumonia (n = 57, 14%), acute renal failure (n = 53,13%), and sepsis (n = 41, 10%). Mortality rate in the DCT group was 61%, versus 17% for definitive thoracotomy (n < 0.001). Utilization of DCT has increased in a linear fashion during the study period, as well as ICU-free days out of 30 (odds ratio, 1.66; 95% confidence interval, 1.18-2.33); however, mortality has not changed over time (odds ratio, 0.61; 95% confidence interval, 0.22-1.98). After mixed logistic regression, there was no difference in complications based on closure type. CONCLUSION The use of DCT is increasing over time with improved ICU-free days, but without improved mortality. Mechanism of temporary closure should be determined based on operator's experience and institutional resources.

AB - BACKGROUND Damage-control thoracotomy (DCT) lacks evidence regarding frequency of use, optimal technique, and outcomes. This Eastern Association for the Surgery of Trauma multicenter trial aimed to examine DCT usage over the last decade, evaluate types of temporary closure, and assess associated outcomes. METHODS An international retrospective cohort study of thoracotomies from 2008 to 2020 at 25 centers was performed. Patients age 16 years or older undergoing thoracotomy within 24 hours of admission who survived to intensive care unit (ICU) admission were included. Mixed logistic regression was used to assess complications associated with closure type, trends in DCT utilization, and mortality. Competing risk regression model was used to determine trends in ICU-free days for DCT over time. RESULTS Nine hundred twenty-two thoracotomy operations were performed, of those 402 (44%) were DCT. Most injuries were penetrating (n = 609, 66%) and the most common mechanism was gunshot wound. Damage-control thoracotomy patients were significantly more injured and ill on presentation. Fifty-four percent of DCT began in the emergency department. Most common temporary closure types included skin only (n = 103, 25%), commercial vacuum device (n = 123,30%), and adhesive dressing (n = 129, 32%). Frequent complications following DCT were pneumonia (n = 57, 14%), acute renal failure (n = 53,13%), and sepsis (n = 41, 10%). Mortality rate in the DCT group was 61%, versus 17% for definitive thoracotomy (n < 0.001). Utilization of DCT has increased in a linear fashion during the study period, as well as ICU-free days out of 30 (odds ratio, 1.66; 95% confidence interval, 1.18-2.33); however, mortality has not changed over time (odds ratio, 0.61; 95% confidence interval, 0.22-1.98). After mixed logistic regression, there was no difference in complications based on closure type. CONCLUSION The use of DCT is increasing over time with improved ICU-free days, but without improved mortality. Mechanism of temporary closure should be determined based on operator's experience and institutional resources.

UR - https://www.scopus.com/pages/publications/105007051155

UR - https://www.scopus.com/pages/publications/105007051155#tab=citedBy

U2 - 10.1097/TA.0000000000004492

DO - 10.1097/TA.0000000000004492

M3 - Article

C2 - 40435348

SN - 2163-0755

VL - 99

SP - 460

EP - 467

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

IS - 3

ER -

Damage control thoracotomy trends, techniques, and outcomes: An EAST multicenter trial

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