Comparison of Post-Removal Complications of Chest Tube Extraction at 48 Versus 72 Hours After Insertion in Trauma Patients

Abstract

Pneumothorax is one of the most common consequences of chest trauma, typically managed with chest tube insertion. However, the optimal timing for chest tube removal remains controversial. This study aimed to compare the incidence of clinical complications following chest tube removal at 48 hours versus 72 hours after insertion in trauma patients admitted to Sina Hospital. This prospective, single-center, parallel- group randomized controlled trial enrolled 194 trauma patients requiring tube thoracostomy. Participants were randomized in a 1:1 ratio using computer-generated block randomization with allocation concealment into two groups: removal at 48 hours (n=97) and removal at 72 hours (n=97). The primary endpoint was post-removal complications, defined as recurrent pneumothorax or incomplete lung re-expansion confirmed radiographically. Absolute risk differences (ARD) with 95% confidence intervals (CI) were calculated. Logistic regression analysis was performed to evaluate potential predictors of complications. Statistical significance was defined as P<0.05. The mean age of patients was 43.27±13.05 years. The 72-hour group had slightly higher mean oxygen saturation than the 48-hour group (94.89% vs. 94.76%, P=0.690), and higher mean heart rate (84.04 vs. 83.11, P=0.507) and respiratory rate (13.44 vs. 13.38, P=0.822). In contrast, mean pain intensity was higher in the 48-hour group (4.03 vs. 3.98, P=0.673). Recurrent pneumothorax occurred in 12 patients (12.4%) in the 48-hour group and 10 patients (10.3%) in the 72-hour group (ARD: 2.1%; 95% CI: −6.8% to 11.0%; P=0.651). Incomplete lung re-expansion occurred in 2 patients (2.1%) and 4 patients (4.1%), respectively (ARD: −2.0%; 95% CI: −6.7% to 2.7%; P=0.407). No statistically significant differences were detected between groups. Logistic regression analysis did not identify independent predictors of post-removal complications. Chest tube removal at 48 hours was not associated with a statistically significant increase in post-removal complications compared with removal at 72 hours. However, confidence intervals were wide, and the findings should be interpreted cautiously pending confirmation in larger adequately powered studies