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World Journal of Surgery
Published in: World Journal of Surgery 6/2017

01-06-2017 | Original Scientific Report

Tube Thoracostomy Complications Increase Cost

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

Published in: World Journal of Surgery | Issue 6/2017

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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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Metadata
Title
Tube Thoracostomy Complications Increase Cost
Authors
Matthew C. Hernandez
Muhammad H. Zeb
Stephanie F. Heller
Martin D. Zielinski
Johnathon M. Aho
Publication date
01-06-2017
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 6/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-017-3897-7

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