Complications in Tube Thoracostomy: Systematic review and Meta-analysis.

Hernandez MC, El Khatib M, Prokop L, Zielinski MD, Aho JM.

J Trauma Acute Care Surg. 2018 Feb 14.Epub ahead of print 

BACKGROUND: Tube thoracostomy (TT) complications and their reported rates are highly variable (1-40%) and inconsistently classified. Consistent TT complication classification must be applied to compare reported literature to standardize TT placement. We aim to determine the overall TT related complication rates in patients receiving TT for traumatic indications utilizing uniform definitions.

METHOD: Systematic review and meta-analysis was performed assessing TT related complications. Comprehensive search of several databases (1975-2015) was conducted. We included studies that reported on bedside TT insertion (≥22 F) in trauma patients. Data were abstracted from eligible articles by independent reviewers with discrepancies reconciled by a third. Analyses were based on complication category subtypes: insertional, positional, removal, infection/immunologic/education and malfunction.

RESULTS: Database search resulted in 478 studies; after applying criteria 29 studies were analyzed representing 4981 TTs. Injury mechanisms included blunt 60% [49-71], stab 27% [17-34], and gunshot 13% [7.8-10]. Overall median complication rate was 19% (95% CI, 14 - 24.3). Complication subtypes included insertional (15.3%), positional (53.1%), removal (16.2%), infection/immunologic (14.8%), malfunction (0.6%). Complication rates did not change significantly over time for insertional, immunologic, or removal p=0.8. Over time, there was a decrease in infectious related TT complications as well as an increase in positional TT complications.

CONCLUSIONS: Generation of evidence based approaches to improve TT insertion outcomes is difficult as a variety of complication classifications have been utilized. This meta-analysis of complications after TT insertion in trauma patients suggests that complications have not changed over time remaining stable at 19% over the past three decades.

LEVEL OF EVIDENCE: III STUDY TYPE: Systematic review and meta-analysis.