Prophylactic Antibiotics In Tube Thoracostomy: A TQIP Analysis

Author(s):
Tyler Holliday; Dina Filiberto; Emily Lenart; Isaac Howley; Cory Evans; Andy Kerwin; Saskya Byerly

Background:

Prophylactic antibiotics (ABX) prior to tube thoracostomy (TT) in trauma patients to decrease the incidence of infectious complications (IC), including empyema and pneumonia, remains controversial.

Hypothesis:

We sought to evaluate outcomes following ABX for TT and hypothesized no difference in the rate of delayed chest intervention (decortication or repeat TT) and mortality.

Methods:

Using the American College of Surgeons Trauma Quality Improvement Program, patients undergoing TT over a three-year period (2019-2021) were identified. Demographics, mechanism, use of ABX, hospital complications, chest-related procedures, and outcomes were obtained. Patients were excluded if incomplete data, antibiotics given after TT, nonsurvivable (chest abbreviated index score [AIS] 6), or non-chest AIS >2. Outcomes included ventilator days, ICU and hospital length of stay (LOS), ipsilateral chest re-intervention free survival (RFS), IC, and mortality. Univariate analysis and multiple logistic regression were performed.

Results:

Seven hundred seventy-one patients met inclusion criteria. Patients were less likely to receive ABX (52 % vs 63%, p=0.005) for penetrating mechanism, and AIS was not uniform between ABX groups (p=0.019). In univariate analysis, ABX was associated with increased ventilator days (3 vs 2, p=0.004) and hospital LOS (184 vs 133 hours, p<0.001), but decreased mortality (2.9% vs 11%, p<0.001). There was no difference in ICU LOS or RFS. By logistic regression, ABX was not associated with a lower risk of IC (OR 2.18, CI 0.54-14.6, p=0.3), but was associated with RFS (OR 1.57, CI 1.03-2.39, p=0.035). Additionally, higher AIS was associated with a higher risk of infectious complications (OR 1.09, CI 1.00-1.19, p=0.041) and RFS (see table 2).

Conclusions:

A TQIP analysis suggests that ABX are associated with improved ipsilateral chest re-intervention free survival. There are many confounders that may affect the decision for ABX and future study is warranted.