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SAN FRANCISCO – , according to a prospective observational study conducted at 14 adult trauma centers.
“The sad part is, I don’t know if it was surprisingly high, but I’m glad somebody has taken the time to document it,” said Robert Sawyer, MD, professor of surgery at Western Michigan University, Kalamazoo, Mich., who comoderated the session at the annual clinical congress of the American College of Surgeons, where the study was presented.
The researchers examined error rates in both insertions and removals, and compared some of the practices and characteristics of trauma centers with unusually good or poor records. The work could begin to inform quality improvement initiatives. “That’s very parallel to where we were 20 or 25 years ago with central venous catheters. We used to put them in and thought it was never a problem, and then we started taking a close look at it and found out, yeah, there was a problem. We systematically made our procedures more consistent and had better outcomes. I think chest tubes is going to be ripe for that,” Dr. Sawyer said in an interview.
“In some ways we have been lying to ourselves. We acknowledge that trainees have a high rate of complications in chest tube insertion and removal, but we haven’t fixed it as a systematic problem. We’re behind in our work to reduce complications for this bedside procedure,” echoed the session’s other comoderator, Tam Pham, MD, professor of surgery at the University of Washington, Seattle, in an interview.
The researchers defined chest tube errors as anything that resulted in a need to manipulate, replace, or revise an existing tube; a worsening of the condition that the tube was intended to address; or complications that resulted in additional length of stay or interventions. A total of 381 chest tubes were placed in 273 patients over a 3-month period, about 55% by residents and about 28% by trauma attending physicians. Around 80% were traditional chest tubes, and most of the rest were Pigtail, with a very small fraction of Trocar chest tubes, according to a pie chart displayed by Michaela West, MD, a trauma surgeon at North Memorial Health, Robbinsdale, Minn., who presented the research.
Dr. West reported a wide range of complication rates among the 14 institutions, ranging from under 10% to nearly 60%, and some centers reported far more complications with removal or insertion, while some had closer to an even split. The overall average rate of insertion complications was 18.7%, and the average for removal was 17.7%.
When the researchers looked at some of the best and worst performing centers, they identified some trends. A total of 98.6% of chest tubes were tunneled in the best-performing centers, while 14.3% were tunneled in the worst. An initial air leak was more common in the best performing centers (52.5% versus 21.7%). Higher performing centers had a greater percentage of patients with gunshot wounds (24.3% versus 13%), and had a longer duration of stay (5.3 days versus 3.4 days; P less than .05 for all).
In the single highest performing center, all chest tubes were removed by midlevel individuals, and the other two best performing centers relied on an attending physician or resident. The worst performing centers often had postgraduate year 1 and 2 residents removing the chest tubes.
Dr. West, Dr. Pham, and Dr. Sawyer have no relevant financial disclosures.
SOURCE: West M et al. Clinical Congress 2019 Abstract.
SAN FRANCISCO – , according to a prospective observational study conducted at 14 adult trauma centers.
“The sad part is, I don’t know if it was surprisingly high, but I’m glad somebody has taken the time to document it,” said Robert Sawyer, MD, professor of surgery at Western Michigan University, Kalamazoo, Mich., who comoderated the session at the annual clinical congress of the American College of Surgeons, where the study was presented.
The researchers examined error rates in both insertions and removals, and compared some of the practices and characteristics of trauma centers with unusually good or poor records. The work could begin to inform quality improvement initiatives. “That’s very parallel to where we were 20 or 25 years ago with central venous catheters. We used to put them in and thought it was never a problem, and then we started taking a close look at it and found out, yeah, there was a problem. We systematically made our procedures more consistent and had better outcomes. I think chest tubes is going to be ripe for that,” Dr. Sawyer said in an interview.
“In some ways we have been lying to ourselves. We acknowledge that trainees have a high rate of complications in chest tube insertion and removal, but we haven’t fixed it as a systematic problem. We’re behind in our work to reduce complications for this bedside procedure,” echoed the session’s other comoderator, Tam Pham, MD, professor of surgery at the University of Washington, Seattle, in an interview.
The researchers defined chest tube errors as anything that resulted in a need to manipulate, replace, or revise an existing tube; a worsening of the condition that the tube was intended to address; or complications that resulted in additional length of stay or interventions. A total of 381 chest tubes were placed in 273 patients over a 3-month period, about 55% by residents and about 28% by trauma attending physicians. Around 80% were traditional chest tubes, and most of the rest were Pigtail, with a very small fraction of Trocar chest tubes, according to a pie chart displayed by Michaela West, MD, a trauma surgeon at North Memorial Health, Robbinsdale, Minn., who presented the research.
Dr. West reported a wide range of complication rates among the 14 institutions, ranging from under 10% to nearly 60%, and some centers reported far more complications with removal or insertion, while some had closer to an even split. The overall average rate of insertion complications was 18.7%, and the average for removal was 17.7%.
When the researchers looked at some of the best and worst performing centers, they identified some trends. A total of 98.6% of chest tubes were tunneled in the best-performing centers, while 14.3% were tunneled in the worst. An initial air leak was more common in the best performing centers (52.5% versus 21.7%). Higher performing centers had a greater percentage of patients with gunshot wounds (24.3% versus 13%), and had a longer duration of stay (5.3 days versus 3.4 days; P less than .05 for all).
In the single highest performing center, all chest tubes were removed by midlevel individuals, and the other two best performing centers relied on an attending physician or resident. The worst performing centers often had postgraduate year 1 and 2 residents removing the chest tubes.
Dr. West, Dr. Pham, and Dr. Sawyer have no relevant financial disclosures.
SOURCE: West M et al. Clinical Congress 2019 Abstract.
SAN FRANCISCO – , according to a prospective observational study conducted at 14 adult trauma centers.
“The sad part is, I don’t know if it was surprisingly high, but I’m glad somebody has taken the time to document it,” said Robert Sawyer, MD, professor of surgery at Western Michigan University, Kalamazoo, Mich., who comoderated the session at the annual clinical congress of the American College of Surgeons, where the study was presented.
The researchers examined error rates in both insertions and removals, and compared some of the practices and characteristics of trauma centers with unusually good or poor records. The work could begin to inform quality improvement initiatives. “That’s very parallel to where we were 20 or 25 years ago with central venous catheters. We used to put them in and thought it was never a problem, and then we started taking a close look at it and found out, yeah, there was a problem. We systematically made our procedures more consistent and had better outcomes. I think chest tubes is going to be ripe for that,” Dr. Sawyer said in an interview.
“In some ways we have been lying to ourselves. We acknowledge that trainees have a high rate of complications in chest tube insertion and removal, but we haven’t fixed it as a systematic problem. We’re behind in our work to reduce complications for this bedside procedure,” echoed the session’s other comoderator, Tam Pham, MD, professor of surgery at the University of Washington, Seattle, in an interview.
The researchers defined chest tube errors as anything that resulted in a need to manipulate, replace, or revise an existing tube; a worsening of the condition that the tube was intended to address; or complications that resulted in additional length of stay or interventions. A total of 381 chest tubes were placed in 273 patients over a 3-month period, about 55% by residents and about 28% by trauma attending physicians. Around 80% were traditional chest tubes, and most of the rest were Pigtail, with a very small fraction of Trocar chest tubes, according to a pie chart displayed by Michaela West, MD, a trauma surgeon at North Memorial Health, Robbinsdale, Minn., who presented the research.
Dr. West reported a wide range of complication rates among the 14 institutions, ranging from under 10% to nearly 60%, and some centers reported far more complications with removal or insertion, while some had closer to an even split. The overall average rate of insertion complications was 18.7%, and the average for removal was 17.7%.
When the researchers looked at some of the best and worst performing centers, they identified some trends. A total of 98.6% of chest tubes were tunneled in the best-performing centers, while 14.3% were tunneled in the worst. An initial air leak was more common in the best performing centers (52.5% versus 21.7%). Higher performing centers had a greater percentage of patients with gunshot wounds (24.3% versus 13%), and had a longer duration of stay (5.3 days versus 3.4 days; P less than .05 for all).
In the single highest performing center, all chest tubes were removed by midlevel individuals, and the other two best performing centers relied on an attending physician or resident. The worst performing centers often had postgraduate year 1 and 2 residents removing the chest tubes.
Dr. West, Dr. Pham, and Dr. Sawyer have no relevant financial disclosures.
SOURCE: West M et al. Clinical Congress 2019 Abstract.
REPORTING FROM CLINICAL CONGRESS 2019