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Tube Thoracostomy Complications Increase Cost

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Abstract

Background

Tube thoracostomy (TT) can be an effective therapy for thoracic pathologies. Ineffective placement of TT is common and associated with significant complications. Complications require additional interventions to repair damaged tissues or replace dysfunctional TT. We hypothesize that complicated TT insertion increases cost to the hospital system.

Methods

Adult trauma patients requiring TT at a level 1 trauma center (2012–2013) were reviewed. Intraoperative or image-guided TT placements were excluded. Baseline demographics and TT insertion cost (normalized and assigned by hospital billing records) were recorded. Costs included initial TT equipment, radiographs, and subsequent operative or radiologic intervention to correct TT complications. Complications were categorized using previously validated method. Secondary outcomes included: number of TT inserted, number of chest radiographs performed, and TT dwell time utilizing a standardized TT discontinuation protocol.

Results

A total of 154 patients with 246 TT were included. Ninety TT (37%) had complication. Complication categories are postremoval (n = 15, 16.7%), insertional (n = 13, 14.4%), positional (n = 62, 68.9%). Overall median complicated TT cost was 9 times greater than uncomplicated TT insertion, p = 0.001. Insertional complications median cost 21 times greater than an uncomplicated, due to operative and radiologic interventions (p = 0.0001). Positional and postremoval complication rates increased median cost by 3 times compared to uncomplicated TT (p = 0.03). Operative or radiologic interventions (n = 10) were performed for organ injury or uncontrolled hemo-/pneumothorax. Increased dwell time median [IQR] was associated with complicated TT compared to uncomplicated 3 [1–5] versus 2 [1–3], p = 0.01.

Conclusion

TT is a common procedure. TT complications are often considered benign. However, patients with a complicated TT insertion, especially related to insertional subtypes, have markedly increased hospitalization costs due to need for operative or radiologic repair.

Level of evidence

Level V—retrospective study.

Study type

This is a retrospective single-institution study.

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Acknowledgements

This publication was made possible by CTSA Grant KL2 TR000136 (Zielinski) from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and grant from the National Heart, Lung, and Blood Institute T32 HL105355 (Aho), a component of the National Institutes of Health (NIH). This publication was made possible by CTSA Grant Number UL1 TR000135.

Authors’ contribution

MCH carried out study design, data collection and analysis, visual graphic creation, and manuscript writing. HMZ was involved in data collection and manuscript editing. JMA performed study design and manuscript editing. SFH and MDZ took part in manuscript editing.

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Authors and Affiliations

  1. Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Matthew C. Hernandez, Muhammad H. Zeb, Stephanie F. Heller, Martin D. Zielinski & Johnathon M. Aho

  2. Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA

    Johnathon M. Aho

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  1. Matthew C. Hernandez
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  2. Muhammad H. Zeb
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  3. Stephanie F. Heller
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  4. Martin D. Zielinski
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  5. Johnathon M. Aho
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Correspondence to Matthew C. Hernandez.

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Hernandez, M.C., Zeb, M.H., Heller, S.F. et al. Tube Thoracostomy Complications Increase Cost. World J Surg 41, 1482–1487 (2017). https://doi.org/10.1007/s00268-017-3897-7

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  • DOI: https://doi.org/10.1007/s00268-017-3897-7

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