Abstract
Background
Chest tube malposition (i.e., failure in inserting a chest tube to the functional sites) is the most common complication during chest tube insertion. Chest tube insertion into the thoracic cavity generally involves two approaches: the anterior approach and the lateral approach. To our knowledge, no report has compared the safety of the anterior approach with that of the lateral approach. In the present study, we compared the risk of chest tube malposition with the anterior or lateral approach for thoracostomy performed for patients with spontaneous pneumothorax by junior and senior residents.
Methods
We retrospectively included patients aged ≥20 years who exhibited primary or secondary spontaneous pneumothorax without pleural adhesion and underwent chest tube drainage performed by junior or senior residents at tertiary care hospital. We collected data on the patients’ age, sex, and body mass index (BMI); setting of chest tube insertion; department where the chest tube was inserted; and other relevant background information. The study exposure involved insertion of the chest tube in the midclavicular line (anterior approach) or the anterior or midaxillary line (lateral approach). The primary outcome was the number of chest tube malpositions. Multiple imputation was used for missing data. The propensity score within each imputed dataset was calculated by using the collected variables. The inverse probability of treatment weighting (IPTW) method was used to adjust for baseline confounders.
Results
We identified 34 and 219 patients who underwent thoracostomy using the midclavicular and lateral approaches, respectively. IPTW analysis revealed that the estimated odds ratio for chest tube malposition in the anterior approach group versus the lateral approach group was 0.61 (95% confidence interval, 0.17–2.11).
Conclusions
In patients being treated for primary or secondary pneumothorax by junior or senior residents, the risk of chest tube malposition in thoracostomies performed using the midclavicular approach may not be lower than that in thoracostomies performed using the lateral approach.
Severe re-expansion pulmonary edema after chest tube insertion for the treatment of spontaneous pneumothorax
