Complications in Tube Thoracostomy: Systematic review and Meta-analysis

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 Corresponding Author: Matthew Hernandez, MD, Department of Surgery, 200 First Street SW, Rochester MN, 55905. Email: Hernandez.matthew@mayo.edu Disclosures and Funding: The authors do not have any relevant disclosures or conflicts of interest for this work and no funding was utilized for this work This work was not previously published or presented. © 2018 Lippincott Williams & Wilkins, Inc.

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