Implementation of Standardized Chest Tube Removal Protocol in Patients with Pneumothorax Following CT Guided Percutaneous Lung Biopsy Reduces Complications

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

KR

Karan Rao, MD

PGY-4 resident, DR/IR ESIR
University of Iowa Hospitals & Clinics

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

HP

Hanh Pham, MS

Research Assistant
University of Iowa College of Public Health
CD

Chad Davis, MD

Interventional Radiology
Saint-Luke's Health System
KC

Knute Carter, Ph.D.

Clinical Associate Professor
University of Iowa College of Public Health
TD

Trent Davis, MD

Interventional Radiology
St. Joseph's Hospital and Medical Center

Disclosure(s):

Karan Rao, MD: No financial relationships to disclose

Purpose: There are scant evidence-based guidelines for chest tube removal (CTR) following tube thoracostomy for pneumothorax (PTX) resulting from CT-guided percutaneous lung biopsy (CT-PLB). We designed a novel, risk stratified CTR protocol and hypothesize that standardized CTR (SCTR) will result in fewer complications compared to non-standardized protocol (NSP) in patients with tube thoracostomy following CT-PLB.

Materials and Methods: An IRB-approved retrospective review of 725 patients who underwent CT-PLB was performed from August 2017-August 2019 (CTR performed via NSP), and August 2020-August 2022 (SCTR, summarized in table 1). High risk patients were those with emphysematous lungs and scarring from prior surgery/radiation. Complications following CTR were defined as re-expansion of PTX or need for an upsized or second chest tube. The p-values for comparing SCTR versus non-standardized protocol were obtained by performing the Kruskal-Wallis and Chi-squared tests.

Results:

Pneumothorax occurred in 195/725 (26.9%) of CT-PLB performed. Tube thoracostomy and subsequent CTR was performed in 92/725 (13%) of CT-PLB, with 44/92 (48%) under the SCTR, and 48/92 (52%) CTR under NSP. Complication rate was significantly lower in the STCR compared to the NSP: 13.6% vs 31.2% (p=0.04), with an overall complication rate of 22.8% (21/92). There was no association between co-morbidities (smoking, emphysematous lungs, underlying thoracic malignancy) and complications following CTR.

Conclusion: Implementation of a risk stratified SCTR protocol was associated with fewer complications compared to a NSP for CTR in patients who underwent tube thoracostomy for pneumothorax following CT-PLB.