Effects of post rib plating tube thoracostomy output on the need for thoracic re-intervention: Does the volume matter?

Negaar Aryan; Jeffry Nahmias; Areg Grigorian; Zoe Hsiao; Avneet Bhullar; Matthew Dolich; Mallory Jebbia; Falak Patel; Jacquelyn Hemingway; Elliot Silver; Sebastian Schubl

doi:10.1016/j.injury.2024.111910

Effects of post rib plating tube thoracostomy output on the need for thoracic re-intervention: Does the volume matter?

Injury. 2025 Jan;56(1):111910. doi: 10.1016/j.injury.2024.111910. Epub 2024 Sep 24.

Authors

Affiliations

¹ University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care. Electronic address: negaara@hs.uci.edu.
² University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care. Electronic address: jnahmias@hs.uci.edu.
³ University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care. Electronic address: agrigori@uci.edu.
⁴ University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care. Electronic address: hsiaoya@hs.uci.edu.
⁵ University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care. Electronic address: akbhulla@hs.uci.edu.
⁶ University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care. Electronic address: mdolich@hs.uci.edu.
⁷ University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care. Electronic address: mjebbia@hs.uci.edu.
⁸ University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care. Electronic address: falakp@hs.uci.edu.
⁹ University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care. Electronic address: jacqulp1@hs.uci.edu.
¹⁰ University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care. Electronic address: emsilver@hs.uci.edu.
¹¹ University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care. Electronic address: sschubl@hs.uci.edu.

PMID: 39384499
DOI: 10.1016/j.injury.2024.111910

Abstract

Background: Surgical stabilization of rib fractures (SSRF) has been demonstrated to improve early clinical outcomes. Tube thoracostomy (TT) is commonly performed with SSRF, however there is a paucity of data regarding when removal of TT following SSRF should occur. This study aimed to compare patients undergoing thoracic reinterventions (reintubation, reinsertion of TT/pigtail, or video-assisted thoracic surgery) to those not following SSRF+TT, hypothesizing increased TT output prior to removal would be associated with thoracic reintervention.

Methods: We performed a single center retrospective (2018-2023) analysis of blunt trauma patients ≥ 18 years-old undergoing SSRF+TT. The primary outcome was thoracic reinterventions. Patients undergoing thoracic reintervention ((+)thoracic reinterventions) after TT removal were compared to those who did not ((-)thoracic reintervention). Secondary outcomes included TT duration and outputs prior to removal.

Results: From 133 blunt trauma patients undergoing SSRF+TT, 23 (17.3 %) required thoracic reinterventions. Both groups were of comparable age. The (+)thoracic reintervention group had an increased injury severity score (median: 29 vs. 17, p = 0.035) and TT duration (median: 4 vs. 3 days, p < 0.001) following SSRF. However, there were no differences in median TT outputs between both cohorts post-SSRF day 1 (165 mL vs. 160 mL, p = 0.88) as well as within 24 h (60 mL vs. 70 mL, p = 0.93) prior to TT removal.

Conclusion: This study demonstrated over 17 % of SSRF+TT patients required a thoracic reintervention. There was no association between thoracic reintervention and the TT output prior to removal. Future studies are needed to confirm these findings, which suggest no absolute threshold for TT output should be utilized regarding when to pull TT following SSRF.

Keywords: SSRF; Surgical stabilization of rib fractures; Thoracic interventions; Tube thoracostomy; Tube thoracostomy output.

MeSH terms

Adult
Bone Plates*
Chest Tubes
Female
Fracture Fixation, Internal / instrumentation
Fracture Fixation, Internal / methods
Humans
Injury Severity Score
Male
Middle Aged
Reoperation* / statistics & numerical data
Retrospective Studies
Rib Fractures* / surgery
Thoracic Injuries / surgery
Thoracic Surgery, Video-Assisted / methods
Thoracostomy* / instrumentation
Thoracostomy* / methods
Treatment Outcome
Wounds, Nonpenetrating* / surgery