Increasing Tube Thoracostomy Output Threshold to Less Than 300 mL Per Day is Not Associated With Increased Complications after Removal in Trauma Patients.

Abstract

BackgroundTube thoracostomy (TT) is a life-saving intervention that has a high complication rate. While many institutions continue drainage until <200 mL/day, there is little data on removal with higher output. This study aimed to determine whether TT removal with higher output on the day of removal is associated with complication of tube thoracostomy (CTT).Materials and MethodsThis was a retrospective study of patients who underwent TT due to traumatic hemothorax/pneumothorax. Data on demographics, admission vital signs, injury details, treatment course, and output on day of removal was collected. Output was classified as HIGH (200-299 mL at removal) or LOW (<200 mL). The primary outcome variable was development of CTT, which was defined as re-accumulation of HTX/PTX, development of an empyema, subsequent TT, or need for thoracic surgery following tube removal.ResultsAfter applying exclusion criteria, we identified 315 patients for analysis. The average age was 41 years old, and 74% (233) were male. The mean duration of treatment with TT was 5 days. The mean output on the day of removal was 80 mL, with 10% having a volume between 200-299 mL on day of removal. Overall, 16% developed CTT. There was no difference in the rate of CTT after removal between HIGH and LOW groups. Multiple variable logistic regression showed only chest AIS was statistically significantly associated with CTT.DiscussionComplications after tube thoracostomy are common (16%), but patients with higher output were not more likely to develop a complication. Chest tubes can be safely removed with an output <300 mL/day.