Thoracic irrigation for traumatic hemothorax: a cost-effective analysis

Recent studies have shown thoracic irrigation after tube thoracostomy drainage of traumatic hemothorax (HTX) reduces the rate of retained HTX and need for secondary interventions such as video-assisted thoracoscopic surgery (VATS) but the cost-effectiveness of thoracic irrigation is not well-studied. We hypothesized that thoracic irrigation after thoracostomy tube drainage of traumatic HTX would be more cost-effective compared to standard tube thoracostomy drainage.

A decision-analytic model was created to evaluate the cost-effectiveness of thoracic irrigation after thoracostomy tube placement for traumatic HTX. Our base case was a 38-year-old hemodynamically stable patient presenting with a traumatic HTX requiring thoracostomy tube placement on presentation. Cost, probabilities, and utilities were obtained from the published literature, with cost represented in 2025 US dollars. Utilities were represented in Quality-Adjusted Life Years (QALY's). One-way sensitivity analysis was performed.

The decision-analytic model identified that thoracic irrigation after thoracostomy tube placement for traumatic HTX was the dominant strategy with lower cost at $17,818 with QALY 0.69 compared to no irrigation at $34,527 with QALY 0.67. The strategy of thoracic irrigation demonstrated an increased net monetary benefit compared to no irrigation ($51,086 vs $32,581) with increased QALY. Using one-way sensitivity analysis, thoracic irrigation was cost-effective when its net monetary benefit surpasses $33,581.

In hemodynamically stable patients, adoption of routine thoracic irrigation for traumatic HTX is cost-effective providing additional benefit at less cost. Adoption of this management strategy should be strongly considered as it may reduce cost and improve quality of life, in addition to previously demonstrated improvement in clinical outcomes.