Introduction: Resuscitative thoracotomy (RT) is a damage control method for patients in extremis, but the clinical trajectory for survivors remains poorly understood. The mortality of postoperative complications, or Failure to Rescue (FTR), has not been well-described in RT survivors. This study sought to characterize severe complications and identify predictors of FTR in RT patients. Methods: The National Inpatient Sample (NIS) from 2016-2020 was queried. The inclusion cohort was created by identifying samples that received either open cardiac massage or aortic cross-clamping on hospital day 0, diagnosis of traumatic cardiac arrest, and length of stay >1 day. Five severe postoperative complications were identified: severe sepsis, acute respiratory distress syndrome (ARDS), pulmonary embolus (PE), acute kidney injury (AKI, requiring dialysis), and severe shock (diagnosis of shock requiring mechanical ventilation or dialysis). The primary outcome was in-hospital mortality after developing a complication. Multivariable logistic regression was used to identify independent predictors of FTR, adjusting for age, Charlson comorbidity index, race, insurance, and hospital characteristics. Systemic inflammatory response syndrome, PE, and ARDS were not reported due to small sample size. Results: Among the 1,178 RT survivors, 55% developed at least one major complication with overall FTR of 38%. Severe sepsis FTR occurred more commonly in the South (OR 3.09, p=0.025, CI 1.15-8.27) and the West (OR 4.32, p=0.004, CI 1.58-11.8) compared to the Midwest and Northeast regions of the country. Severe AKI with FTR was more commonly seen with Native American race (OR 7.27, p=0.024, CI 1.29-40.65). Patients with private insurance had a decreased rate of FTR in survivors with severe shock (OR 0.45, p=0.013, CI 0.24-0.84). Gender, age, hospital teaching status, and location (rural vs urban) were not associated with increased occurrence of FTR after a major complication. Conclusions: Racial, socioeconomic, and regional disparities impact FTR after RT. Nationwide analysis reveals disparities in the odds of surviving major complications after RT. These findings highlight inequities in critical care and suggest that efforts to improve survival must address factors beyond initial resuscitation.
Gabriel et al. (Sun,) studied this question.