577 - Comparing Immediate Complications of Tube Thoracostomy Placement by Emergency Medicine and Surgery
Wednesday, May 13, 2020
Location: Majestic Ballroom: Majestic
Background and Objectives: Chest tube thoracostomy is a common procedure with highly variable complications rates, but how often and severe are complications of tube thoracostomy placed by Emergency Medicine (EM) vs Surgery residents and faculty? A previous study of 76 chest tubes placed by resident physicians in a 12-month period found a 40% complication rate when placed by EM and a 7% complication rate when placed by General Surgery. This study sought to determine if there is significant evidence of a difference in complication rates between EM vs Surgery calling for a selective reduction in the indications of tube thoracostomy placed by EM physicians in the Emergency Department (ED).
Methods: The data was analyzed using a retrospective chart review of patients who underwent tube thoracostomy by EM and Surgery residents and faculty in a large Midwest teaching institution. A 27-month period of EM, and a 60-month period of Surgery placed tubes were analyzed. Using a query of department billing records, 859 patients were identified and analyzed for complications during chest tube placement using Fisher’s Exact test.
Results: Of 859 patients, 46 were excluded due to receiving the initial thoracostomy at an outside hospital, during transport, or by other services. Of the remaining patients, 227 tubes were placed by EM and 586 by Surgery physicians. 5.73% of the EM placed tubes had complications vs 3.41% from Surgery. Of the 13 EM vs 20 Surgery complications, 76.9% vs 55% were due to positioning, 15.4% vs 25% had an initially kinked tube, and 7.7% vs 20% had more serious complications. Comparing EM vs Surgery tubes in this study, the 95% CI of observed proportion is 0.29 to 1.19, with an odds ratio of 0.58, a significance level of 0.16 and a power of 0.002. With 227 EM tubes in this study, compared with 20 EM tubes in a previous study, the 95% CI of observed proportion is 3.58 to 30.02, with an odds ratio of 10.97 and a significance level of P<0.0001.
Conclusion: This study reveals a lower complication rate from tube thoracostomy than previous studies have shown. With a larger sample size and longer analysis period, this study contradicts the previous studies conclusion that non-surgical trained physicians are responsible for higher rates and more serious complications. Limitations of this study include performance of a retrospective chart review and reliance on immediate procedural complications.