We retrospectively reviewed the medical records of 145 patients with diagnosis of thoracoabdominal injuries and thoracic and abdominal injuries, who underwent surgery in the Emergency Service of Santa Casa de São Paulo, from July 1987 to February 1996. Stab wounds occurred in 72 patients and gunshot wounds in the remaining 73. We focused the analysis on factors related to postoperative complications, length of stay and mortality. Patients were classified using trauma severity score, both physiological (RTS) and anatomical (ISS, PATI, P1TI and PTI). Thoracotomy was correlated with complications. Thoracoabdominal injuries, in general, showed greater incidence of complications when the control variable was stab wounds. The analysis by complication types proved that such difference was caused by pleural empyema. Factors correlating to the occurrence of pleural empyema were: type of injuried (stomach, esophagus and rectum), presence of digestive fistula, stab wounds, and diaphragmatic wound. Length of stay increased due to the occurrence of complications, and not because of the presence of a diaphragmatic wound. Death rates were closely related with increased number of injuries, renal wounds, great vessels and esophageal injuries, infections and gunshot wounds. We concluded that a greater number of organic damages was observed in those patients sustaining penetrating thoraco-abdominal wounds, despite the same postoperative mortality, when compared with those compromised with thoracic and abdominal wounds ( without diaphagmatic injury). Regarding morbidity, the increased incidence of pleural empyema in the thoracoabdominal injuries was related with diaphragmatic injury by stab wounds.
Thoracic trauma; Thoraco-abdominal injuries; Thoracic and abdominal injuries