Prospective Evaluation of Chest Tube Thoracostomy Placement by General Surgery Residents at Two Level I Trauma Centers.

Abstract

IntroductionOur study proposes to define accuracy of and identify areas in general surgery residents (GSR) chest tube thoracostomy (CTT) placement addressable by improved education and supervision.MethodsProspective study of resident-performed CTT from June-August 2023 and 2024 in two Level 1 trauma centers. Data collection/analysis included demographics, tube type, proceduralist PGY, placement accuracy, patient factors, and outcomes.ResultsSeventy-seven CTT were placed by GSR. Average patient age was 57 ± 16.8. 75% were male. Smokers, COPD diagnosis, and prior chest wall radiation patients experienced more resident-CTT placement errors. CTT were standard 28-32F tubes (58; 75%) and small-bore pleural catheters (19; 25%). CTT was adequate in 62 (80.5%), 19.5% were sub-optimal. Placement problems included sentinel hole outside the chest (7, 9.1%), extrapleural location (5, 6.5%), kinked tube (3, 3.9%), and ineffective fissural tube (1, 1.3%). Interns placed 41 CTT, 7 by PGY-2, 11 by PGY-3, 7 by PGY-4, and 10 PGY-5 surgery residents. PGY-1 residents had a higher incidence of CTT retraction (35%, P = 0.042). Retracted, poorly secured CTT had a longer duration compared to well-secured CTT (6 days [4-7] vs 3 [2-4], P = 0.019); but didn't affect hospital LOS (P = 0.651). No other differences based on PGY were noted.DiscussionGSR's CTT placement has an accuracy of 80%. Placement problems occur at all levels of residency training. Our findings highlight actionable training targets and recommend areas of enhanced supervision to improve GSR mastery of CTT.