Small Caliber Tube Thoracostomy Leads to Shorter Length of Stay in Spontaneous Pneumothorax: A Single Institution Experience
Beth Meloro, Hau Phan, Haji Shariff
Mercy Catholic Medical Center, Darby, PA, USA
OBJECTIVE: At our institution, spontaneous pneumothorax is managed with tube thoracostomy. The objective of this study is to determine optimal insertion technique and management of tube thoracostomy to decrease length of stay and total time with tube thoracostomy in patients with spontaneous pneumothorax.
METHODS: We retrospectively identified patients with spontaneous pneumothorax over seven years. We studied patients requiring tube thoracostomy to determine differences in length of stay and total days with tube thoracostomy depending on the specialty of physician inserting the tube, and caliber of tube initially inserted. GraphPad QuickCalcs was used for data analysis. Descriptive statistics were calculated to determine relationships between variables. T-tests were used to determine statistical significance.
Results: Overall length of stay ranged from 1.05 days to 33.4 days with a mean of 7.19 days (SD 5.34 days, 95% CI 6.00-8.38). Patients whose chest tube was initially placed by emergency room physicians had a 3.1 day shorter stay than those with initial chest tube placement by interventional radiology or surgery (p=0.017). Additionally, patients whose initial chest tube was of small caliber (<14 Fr) had a 3 day shorter stay than those with large bore (>20 Fr) chest tubes on initial insertion (p=0.013).
CONCLUSIONS: Our study determined a statistically significant difference in length of stay dependent on initial insertion by emergency department physicians. Initial insertion of smaller caliber tubes (<14Fr) was associated with decreased length of stay. Overall, further research is needed to determine optimal management of patients with spontaneous pneumothorax to initiate an evidence-based management protocol.
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