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

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.