C52-07 Time to Safe Chest Tube Removal After Water-Seal Trial in Patients With a Traumatic Pneumothorax

Background Thoracic trauma can lead to either a pneumothorax or a hemothorax requiring chest tube insertion. Chest tubes (CT) can be managed with active suction and/or a water-seal (WS) system, yet optimal timing for water-seal duration before safe removal remains unclear. The purpose of our study is to evaluate the impact of WS duration on tube thoracostomy failure rates. Methods We performed a retrospective cohort analysis in patients admitted to our urban, Level I trauma center requiring tube thoracostomy for thoracic trauma between January 1, 2016, and October 1, 2022. The primary model was removal of the chest tube after a single water seal (SWS) course. Secondary model included CT duration. Results Fifty-four patients underwent a tube thoracostomy and 33 (61.1%) had successful removal of the chest tube after a SWS course. Twenty-one (38.3%) patients had worsening clinical or radiological findings requiring reapplication of suction to the chest tube. In a subgroup analysis of patients that failed a SWS course, there was no significant correlation between WS duration and failure (p = 0.21). Total CT duration (suction time + WS) predicted failure, with each additional 12-hour increasing the odds by 39% (OR = 1.39, 95% CI: 1.09-1.78, p = 0.008). Mean hospital length of stay was also longer among patients who failed SWS (11.0 ± 8.3 days vs 7.5 ± 6.4 days, p = 0.015). Conclusion WS duration did not significantly impact thoracostomy failure rates, suggesting flexibility in trial length may be safe. Conversely, longer total CT duration increases failure likelihood, emphasizing the need to optimize removal timing. This abstract is funded by: None