Analysis of Patients Discharged From the Hospital With a Chest Tube in Place

J. Matthew Reinersman, Mark S. Allen, Shanda H. Blackmon, Stephen D. Cassivi, Francis C. Nichols, Dennis A Wigle, K. Robert Shen

Research output: Contribution to journalArticle

Abstract

Background: Persistent air leak can complicate pulmonary resection, and one management option is dismissal with a chest tube in place. This study evaluated the rate of empyema and readmission after dismissal with a chest tube. Methods: A retrospective review of our prospective database from January 2004 to December 2013 identified 236 patients who were discharged from our institution with an indwelling chest tube and attached one-way valve for air leak. Empyema was defined by leukocytosis or fever and undrained effusion on chest roentgenogram or computed tomography. Readmission was defined as readmission for any reason. Logistic regression analyses were performed to identify risk factors for empyema or readmission. Results: Median age was 67 years (range, 18 to 91 years). Median chest tube duration was 18 days (range, 6 to 90 days). Empyema occurred in 40 patients (16.9%), and 62 patients (26.3%) were readmitted. Treatment required included antibiotics alone in 45% (18 of 40), further drainage in 30% (12 of 40), fibrinolytic therapy in 12.5% (5 of 40), and operative decortication in 12.5% (5 of 40). Predictors of empyema included male sex, coronary artery disease, and peripheral vascular disease. A secondary analysis grouping patients into an earlier era (2004 to 2008) vs a later era (2009 to 2013) revealed that the use of thoracoscopy increased from 34% to 48% of lung resections and dismissal with a chest tube increased from 3.4% to 4.5% (p = 0.03). Conclusions: Dismissal with an indwelling chest tube is not without consequence, having significant risk for further complications and potential need for additional interventions.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Chest Tubes
Empyema
Air
Thoracoscopy
Lung
Peripheral Vascular Diseases
Thrombolytic Therapy
Leukocytosis
Coronary Artery Disease
Drainage
Fever
Thorax
Logistic Models
Tomography
Regression Analysis
Databases
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Reinersman, J. M., Allen, M. S., Blackmon, S. H., Cassivi, S. D., Nichols, F. C., Wigle, D. A., & Shen, K. R. (Accepted/In press). Analysis of Patients Discharged From the Hospital With a Chest Tube in Place. Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2017.10.042

Analysis of Patients Discharged From the Hospital With a Chest Tube in Place. / Reinersman, J. Matthew; Allen, Mark S.; Blackmon, Shanda H.; Cassivi, Stephen D.; Nichols, Francis C.; Wigle, Dennis A; Shen, K. Robert.

In: Annals of Thoracic Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Reinersman, J. Matthew ; Allen, Mark S. ; Blackmon, Shanda H. ; Cassivi, Stephen D. ; Nichols, Francis C. ; Wigle, Dennis A ; Shen, K. Robert. / Analysis of Patients Discharged From the Hospital With a Chest Tube in Place. In: Annals of Thoracic Surgery. 2018.
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AB - Background: Persistent air leak can complicate pulmonary resection, and one management option is dismissal with a chest tube in place. This study evaluated the rate of empyema and readmission after dismissal with a chest tube. Methods: A retrospective review of our prospective database from January 2004 to December 2013 identified 236 patients who were discharged from our institution with an indwelling chest tube and attached one-way valve for air leak. Empyema was defined by leukocytosis or fever and undrained effusion on chest roentgenogram or computed tomography. Readmission was defined as readmission for any reason. Logistic regression analyses were performed to identify risk factors for empyema or readmission. Results: Median age was 67 years (range, 18 to 91 years). Median chest tube duration was 18 days (range, 6 to 90 days). Empyema occurred in 40 patients (16.9%), and 62 patients (26.3%) were readmitted. Treatment required included antibiotics alone in 45% (18 of 40), further drainage in 30% (12 of 40), fibrinolytic therapy in 12.5% (5 of 40), and operative decortication in 12.5% (5 of 40). Predictors of empyema included male sex, coronary artery disease, and peripheral vascular disease. A secondary analysis grouping patients into an earlier era (2004 to 2008) vs a later era (2009 to 2013) revealed that the use of thoracoscopy increased from 34% to 48% of lung resections and dismissal with a chest tube increased from 3.4% to 4.5% (p = 0.03). Conclusions: Dismissal with an indwelling chest tube is not without consequence, having significant risk for further complications and potential need for additional interventions.

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