Increasing Tube Thoracostomy Output Threshold to Less Than 300 mL Per Day is Not Associated With Increased...

Area of Science:

• Thoracic Surgery
• Trauma Surgery
• Critical Care Medicine

Background:

• Tube thoracostomy (TT) is a critical intervention for managing hemothorax and pneumothorax.
• High complication rates are associated with TT, necessitating optimized removal protocols.
• Current guidelines often recommend drainage until output is <200 mL/day, but evidence for higher output removal is limited.

Purpose of the Study:

• To investigate the association between higher daily fluid output at the time of removal and the incidence of complications following tube thoracostomy.
• To evaluate the safety of removing chest tubes in patients with traumatic hemothorax/pneumothorax when daily drainage volume exceeds 200 mL.

Main Methods:

• Retrospective analysis of 315 patients who underwent TT for traumatic hemothorax/pneumothorax.
• Patients were categorized into HIGH (200-299 mL/day) and LOW (<200 mL/day) output groups on the day of removal.
• Complications of tube thoracostomy (CTT) were defined as re-accumulation of fluid, empyema, repeat TT, or need for thoracic surgery.

Main Results:

• Overall, 16% of patients developed CTT.
• No statistically significant difference in CTT rates was observed between the HIGH and LOW output groups.
• Chest Abbreviated Injury Scale (AIS) was the only factor significantly associated with CTT in multivariable analysis.

Conclusions:

• Tube thoracostomy removal with a daily output of 200-299 mL is not associated with an increased risk of complications.
• Chest tubes can be safely removed when daily output is less than 300 mL, potentially shortening drainage duration.
• Optimizing TT removal criteria may help reduce patient morbidity and healthcare resource utilization.