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

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Thoracostomy for removal of excess fluid in surgical stabilization of rib fractures: the T-REX trial. European journal of trauma and emergency surgery : official publication of the European Trauma Society Majercik, S., Gardner, S., Eriksson, E. A., Forrester, J. D., Villarreal, J. A., Bauman, Z. M., Cavlovic, L., Doben, A. R., Semon, G. R., Pieracci, F. M., Morin, T., Mancine, K., Warriner, Z. D., Neff, C., Whitbeck, S. S., White, T. W. 2025; 51 (1): 174

Abstract

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.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.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

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