A. F. Elegbede1, B. W. Carr1, B. L. Zarzaur1, S. A. Savage1 1Indiana University School Of Medicine,Indianapolis, IN, USA
Introduction:
Thoracic trauma is a significant source of mortality in multiply injured patients. The vast majority will be managed solely with tube thoracostomy, however, and chest tube insertion remains one of the most commonly performed procedures. A common complication related to chest tube removal is recurrent pneumothorax (R-Ptx). R-Ptx has been linked to the need for additional procedures and may increase hospital length of stay (LOS). Though multiple studies have focused on tube removal techniques to best reduce R-Ptx, there have been few reports regarding other factors that may predispose to R-Ptx.
Methods:
A retrospective chart review was performed for all patients requiring chest tubes from January to July 2016 at a single Level 1 trauma center. Data collected included patient demographics, injury characteristics, information regarding chest tube placement and any complications related to the intervention. Groups were compared using either χ2 or Kruskal Wallis tests as appropriate. Multivariable logistic regression was used to compare outcomes.
Results:
106 patients were included in this study. 75% of the patients were male, 83% suffered a blunt mechanism, the mean age was 48 years (SD 20.7) and mean chest AIS was 3.1 (SD 0.89). There were no differences between groups in terms of gender, overall ISS, or chest AIS. Patients in the R-Ptx group were significantly younger (40 years (SD 17) vs 54 years (SD 21), p=0.0004), had a significantly lower body mass index (BMI) (25.3 (SD 5.7) vs 29.4 (SD 7), p=0.0031), and a higher rate of penetrating trauma (28% vs 9.5%, p=0.0179). With multivariable logistic regression, both age and BMI remained significantly associated with R-Ptx (Table 1). When excluding patients with trace or small R-Ptx (<1 cm), BMI remained associated with recurrence (Table 1). ICU LOS was no different between groups (R-Ptx 4 days (IQR0, 16); no R-Ptx 6 days (IQR 2, 13), p=0.2807). However, R-Ptx patients had a significantly shorter hospital LOS (10 days (IQR 7, 14)) compared to no R-Ptx patients (12 days (IQR 7, 20), p=0.0088).
Conclusion:
Recurrent pneumothorax is a complication of thoracostomy tube placement that may delay recovery and discharge. In our study, patients with a higher BMI and older age were protected from recurrence compared to our younger patients suffering penetrating trauma. This may in part be due increased subcutaneous tissue preventing entrainment of air during tube removal. Counterintuitively, despite the R-Ptx, these patients actually had a significantly shorter hospital LOS. The very factors which predispose patients to recurrence may allow faster recovery and earlier discharge. R-Ptx may not have a significant negative impact on duration of hospital stay.
