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

BackgroundPneumonectomy remains a rare trauma procedure due to its high morbidity and mortality. While previous studies suggest that right-sided pneumonectomy is associated with a higher mortality in patients with lung cancer, there are scarce data in trauma. We aimed to compare patient outcomes following right-sided and left-sided pneumonectomy after trauma.MethodsThis is a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database (2016-2022). Trauma patients (age ≥16 years) who underwent pneumonectomy were included and stratified by the laterality of pneumonectomy. Patient baseline characteristics, injury profile, and clinical outcomes were compared between the right- and left-sided pneumonectomy groups. Multivariable analysis was performed to evaluate the association between the laterality of pneumonectomy and in-hospital mortality.ResultsA total of 301 patients were included. The median age was 30 years, and 85.3% were male. Of those, 137 patients (45.5%) underwent right-sided pneumonectomy. Admission vital signs and Injury Severity Score were comparable between the right- and left-sided groups. Extracorporeal membrane oxygenation (ECMO) was used more frequently in right-sided pneumonectomy patients (8.8% vs 2.4%, P = 0.015). In-hospital mortality following right- and left-sided pneumonectomy was 54.0% and 48.2%, respectively (P = 0.313). In the multivariable logistic regression, right-sided pneumonectomy was not associated with increased odds of in-hospital mortality (adjusted odds ratio: 1.137, confidence interval: 0.641-2.015, P = 0.662).ConclusionThis study suggests that the laterality of pneumonectomy was not associated with an increased risk of in-hospital mortality. Future research should evaluate the utility of ECMO in trauma patients requiring pneumonectomy.