Thoracostomy for removal of excess fluid in surgical stabilization of rib fractures: the T-REX trial.

BACKGROUND

Management of the pleural space during and after SSRF is a matter of debate. Tube thoracostomy (TT), intra-operative pleural lavage (PL) and video assisted thoracoscopic surgery (VATS) use varies between surgeons. The purpose of this study is to describe differences in practice patterns of pleural space management (TT, PL, VATS) after SSRF at institutions with extensive experience in chest wall reconstruction.

METHODS

Prospective data from adult SSRF patients at eight U.S. trauma centers between January 1, 2020 and September 1, 2022 was collected. Patients were managed according to institutional protocols. Outcome measures included hospital and ICU length of stay, 30-day readmission rate, infectious complications, and incidence of procedural re-intervention. Discrete variables are reported as median (IQR). P-values for continuous variables were obtained using Kruskal-Wallis, and for categorical variables using Chi-square.

RESULTS

273 patients from 8 centers were included. Median age was 60 (46-68), 70% were male, and 99% suffered blunt trauma. ISS was 17 (13-26), ranging from a low of 14 (10-19) to 26 (18-35) (p = 0.002). Median operative time was 2.5 (1.9-3.3) hours, with 5 (4-6) plates placed. VATS ranged from 2 to 78% at each center and PL ranged from 25 to 100% (p < 0.001). Almost all patients received TT. TT remained in place for 3 (2-4) days, few (2%) had any complication related to the TT, nor did they require drain replacement (7%) or reoperation (2%). ICU and hospital lengths of stay were 3 (2-6) and 8 (6-13) days (P < 0.001). Readmission rates were low (4%), and did not differ between centers.

CONCLUSION

At centers experienced in SSRF, there is variation in management of the pleural space. While ICU and hospital lengths of stay are different between centers, rates of reoperation and readmission are similar. Further study is needed to delineate optimal management of the pleural space after SSRF.