Faculty Collaboration Database

Thoracostomy tube function not trajectory dictates reintervention. J Surg Res 2016 Dec;206(2):380-385

Date

11/26/2016

Pubmed ID

27884332

DOI

10.1016/j.jss.2016.08.021

Scopus ID

2-s2.0-84989958894 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

BACKGROUND: Hemothorax and/or pneumothorax can be managed successfully managed with tube thoracostomy (TT) in the majority of cases. Improperly placed tubes are common with rates near 30%. This study aimed to determine whether TT trajectory affects the rate of secondary intervention.

METHODS: A retrospective review of all adult trauma patients undergoing TT placement over a 4-y period was performed. TT trajectory was classified as ideal, nonideal, or kinked-based on anterior-posterior chest x-ray. TTs with sentinel port outside the thoracic cavity were excluded. The primary outcome was any secondary intervention.

RESULTS: Four-hundred eighty-six patients and a total of 547 hemithoraces underwent placement and met inclusion criteria. The majority of patients were male (76%), with a median age of 41 y, and majority suffered blunt trauma ideal trajectory was identified in 429 (78.4%). Kinked TTs were noted in 33 (6%) hemothoraces with a 45.5% replacement rate. Review with staff demonstrates inherent bias to replace kinked TTs. The overall secondary intervention rate was 27.8%. Kinked TTs were removed from final analysis due to treatment bias. Subsequent analysis demonstrated no significant difference between ideal and nonideal trajectories (25.1% versus 34.1%, P = 0.09).

CONCLUSIONS: Intrathoracic trajectory of nonkinked TTs with the sentinel port within the thoracic cavity does not affect secondary intervention rates, including the rate of surgical intervention.

Author List

Kugler NW, Carver TW, Knechtges P, Milia D, Goodman L, Paul JS

Authors

Thomas W. Carver MD Associate Professor in the Surgery department at Medical College of Wisconsin
Nathan W. Kugler MD Assistant Professor in the Surgery department at Medical College of Wisconsin
David J. Milia MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Chest Tubes
Equipment Failure
Female
Follow-Up Studies
Hemothorax
Humans
Male
Middle Aged
Pneumothorax
Reoperation
Retrospective Studies
Thoracostomy
Treatment Outcome
Young Adult