Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Aug;85(2):410-416.
doi: 10.1097/TA.0000000000001840.

Complications in tube thoracostomy: Systematic review and meta-analysis

Matthew C Hernandez  1 , Moustafah El Khatib, Larry Prokop, Martin D Zielinski, Johnathon M Aho
Affiliations
Meta-Analysis

Complications in tube thoracostomy: Systematic review and meta-analysis

Matthew C Hernandez et al. J Trauma Acute Care Surg. 2018 Aug.

Abstract

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 using uniform definitions.

Methods: 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 Fr) 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 4,981 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% confidence interval, 14-24.3). Complication subtypes included insertional (15.3%), positional (53.1%), removal (16.2%), infection/immunologic (14.8%), and 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 TT-related complications as well as an increase in positional TT complications.

Conclusion: Generation of evidence-based approaches to improve TT insertion outcomes is difficult because a variety of complication classifications has been used. 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: Systematic review and meta-analysis, level III.

PubMed Disclaimer

Figures

Figure 1
Figure 1
PRISMA Flow diagram
Figure 2
Figure 2
Individual complication rates for included studies adjusted using standardized classifications
Figure 3
Figure 3
Median [IQR] Rate of complication subtypes during thirty years
Figure 4
Figure 4
Traumatic mechanism during the past thirty years requiring tube thoracostomy
See this image and copyright information in PMC

References

    1. Hernandez MC, Zeb MH, Heller SF, Zielinski MD, Aho JM. Tube Thoracostomy Complications Increase Cost. World J Surg. 2017;41(6):1482–1487. - PubMed
    1. Hernandez MC, Laan DV, Zimmerman SL, Naik ND, Schiller HJ, Aho JM. Tube thoracostomy: Increased angle of insertion is associated with complications. J Trauma Acute Care Surg. 2016;81(2):366–70. - PMC - PubMed
    1. Chan L, Reilly KM, Henderson C, Kahn F, Salluzzo RF. Complication rates of tube thoracostomy. Am J Emerg Med. 1997;15(4):368–70.7. - PubMed
    1. Millikan JS, Moore EE, Steiner E, Aragon GE, Van Way CW., 3rd Complications of tube thoracostomy for acute trauma. Am J Surg. 1980;140(6):738–41. - PubMed
    1. LoCurto JJ, Jr, Tischler CD, Swan KG, Rocko JM, Blackwood JM, Griffin CC, Lazaro EJ, Reiner DS. Tube thoracostomy and trauma--antibiotics or not? J Trauma. 1986;26(12):1067–72. - PubMed

MeSH terms