Abstract
Background: The knowledge of management strategies for non-traumatic PT is sparse.
Aim: To compare the efficacy and complications of surgical (large-bore) chest tube drainage with smaller chest tubes inseted by Seldinger technique in patients with non-traumatic PT.
Methods: A retrospective study of all patients admitted to Hvidovre Hospital, DK, with non-traumatic PT between 01.04.2009 and 31.12.2011. During regular hours (08.00-15.00) on weekdays non-traumatic PTs are managed by chest physicians and by orthopedic surgeons the remaining hours. Chest physicians used Seldinger technique. In general, a True-Close thoracic vent with Heimlich valve, size Fr11-13, while surgeons used chest tubes, size Fr20-28, inserted though a small thoracotomy. Data were analyzed for overall trends and differences in demographic data and short-term outcomes such as complications, duration of drainage time and duration of hospital stay.
Results: In total, 104 episodes of PT were analyzed: 62 PSP, 30 SSP, and 12 iatrogenic PT. An overall incidence of PT was 10/100,000. There were no differences between patients, type of PT, or size of PT comparing the 62 episodes managed by surgeons with the 42 episodes managed by chest physicians.
Patients with large-bore drains managed by surgeons had more complications (33.3% vs 14.5%; P=0.026), lower success rate at primary tube placement (56.5% vs 85.7%; P=0.002) and longer hospital stays (11.8 vs 6.9 days; P=0.004) than patients treated with smaller chest tubes.
Conclusion: Our results support the BTS guidelines in recommending minimal invasive approach in management of non-traumatic PT.
- © 2013 ERS
