title: Tube Thoracostomy Complications Increase Cost.
abstract: Tube thoracostomy (TT) can be an effective therapy for thoracic pathologies. Ineffective placement of TT is common and associated with significant complications. Complications require additional interventions to repair damaged tissues or replace dysfunctional TT. We hypothesize that complicated TT insertion increases cost to the hospital system.
  
  
  
  Adult trauma patients requiring TT at a level 1 trauma center (2012-2013) were reviewed. Intraoperative or image-guided TT placements were excluded. Baseline demographics and TT insertion cost (normalized and assigned by hospital billing records) were recorded. Costs included initial TT equipment, radiographs, and subsequent operative or radiologic intervention to correct TT complications. Complications were categorized using previously validated method. Secondary outcomes included: number of TT inserted, number of chest radiographs performed, and TT dwell time utilizing a standardized TT discontinuation protocol.
  
  
  
  A total of 154 patients with 246 TT were included. Ninety TT (37%) had complication. Complication categories are postremoval (n = 15, 16.7%), insertional (n = 13, 14.4%), positional (n = 62, 68.9%). Overall median complicated TT cost was 9 times greater than uncomplicated TT insertion, p = 0.001. Insertional complications median cost 21 times greater than an uncomplicated, due to operative and radiologic interventions (p = 0.0001). Positional and postremoval complication rates increased median cost by 3 times compared to uncomplicated TT (p = 0.03). Operative or radiologic interventions (n = 10) were performed for organ injury or uncontrolled hemo-/pneumothorax. Increased dwell time median [IQR] was associated with complicated TT compared to uncomplicated 3 [1-5] versus 2 [1-3], p = 0.01.
  
  
  
  TT is a common procedure. TT complications are often considered benign. However, patients with a complicated TT insertion, especially related to insertional subtypes, have markedly increased hospitalization costs due to need for operative or radiologic repair.
  
  
  
  Level V-retrospective study.
  
  
  
  This is a retrospective single-institution study.
authors.affiliation: Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. hernandez.matthew@mayo.edu.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Hernandez
authors.affiliation: Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Muhammad H
authors.initials: MH
authors.lastname: Zeb
authors.affiliation: Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Stephanie F
authors.initials: SF
authors.lastname: Heller
authors.affiliation: Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Zielinski
authors.affiliation: Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.|Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Johnathon M
authors.initials: JM
authors.lastname: Aho
mesh_terms: D000328:Adult; D000368:Aged; D015505:Chest Tubes; D004180:Direct Service Costs; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology; D011183:Postoperative Complications / Q000191:economics*; D013902:Radiography, Thoracic / Q000191:economics; D012044:Regression Analysis; D012189:Retrospective Studies; D013907:Thoracostomy / Q000009:adverse effects / Q000191:economics*; D014193:Trauma Centers