Thoracic irrigation for prevention of secondary intervention after thoracostomy tube drainage for hemothorax: A Western Trauma Association multicenter study. J Trauma Acute Care Surg 2024 Nov 01;97(5):724-730
Date
05/20/2024Pubmed ID
38764139DOI
10.1097/TA.0000000000004364Scopus ID
2-s2.0-85207595483 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
BACKGROUND: Retained hemothorax (rHTX) requiring intervention occurs in up to 20% of patients who undergo chest tube (TT) placement for a hemothorax (HTX). Thoracic irrigation at the time of TT placement decreases the need for secondary intervention in this patient group but those findings are limited because of the single-center design. A multicenter study was conducted to evaluate the effectiveness of thoracic irrigation.
METHODS: A multicenter, prospective, observational study was conducted between June 2018 and July 2023. Eleven sites contributed patients. Patients were included if they had a TT placed for a HTX and were excluded if: younger than 18 years, TT for pneumothorax, thoracotomy or video-assisted thoracoscopic surgery performed within 6 hours of TT, TT >24 hours after injury, TT removed <24 hours, or death within 48 hours. Thoracic irrigation was performed at the discretion of the attending. Each hemithorax was considered separately if bilateral HTX. The primary outcome was secondary intervention for HTX-related complications (rHTX, effusion, or empyema). Secondary intervention was defined as: TT placement, instillation of thrombolytics, video-assisted thoracoscopic surgery, or thoracotomy. Irrigated and nonirrigated hemithoraces were compared using a propensity weighted analysis with age, sex, mechanism of injury, Abbreviated Injury Scale chest, and TT size as predictors.
RESULTS: Four hundred ninety-three patients with 462 treated hemothoraces were included, 123 (25%) had thoracic irrigation at TT placement. There were no significant demographic differences between the cohorts. Fifty-seven secondary interventions were performed, 10 (8%) and 47 (13%) in the irrigated and non-irrigated groups, respectively ( p = 0.015). Propensity weighted analysis demonstrated a reduction in secondary interventions in the irrigated cohort (odds ratio, 0.56 (0.34-0.85); p = 0.005).
CONCLUSION: This Western Trauma Association multicenter study demonstrates a benefit of thoracic irrigation at the time of TT placement for a HTX. Thoracic irrigation reduces the odds of a secondary intervention for rHTX-related complications by 44%.
LEVEL OF EVIDENCE: Therapeutic/Care Management; Level II.
Author List
Carver TW, Berndtson AE, McNickle AG, Boyle KA, Haan JM, Campion EM, Biffl WL, Carroll AN, Sise MJ, Berndt KS, Burris JM, Kopelman TR, Blank JJ, Seamon MJ, Peschman JR, Morris RS, Kugler NW, Conrardy RD, Szabo A, de Moya MAAuthors
Jacqueline Blank MD Assistant Professor in the Surgery department at Medical College of WisconsinThomas W. Carver MD Professor in the Surgery department at Medical College of Wisconsin
Ryan D. Conrardy Biostatistician I in the Data Science Institute department at Medical College of Wisconsin
Rachel S. Morris MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Jacob R. Peschman MD Associate Professor in the Surgery department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Data Science Institute department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultChest Tubes
Drainage
Female
Hemothorax
Humans
Male
Middle Aged
Postoperative Complications
Prospective Studies
Therapeutic Irrigation
Thoracic Injuries
Thoracic Surgery, Video-Assisted
Thoracostomy
