Takeda Kenichiro, Kasai Hajime, Shimizu Ikuo, Hirama Ryutaro, Hayama Nami, Shikano Kohei, Abe Mitsuhiro, Naito Akira, Suzuki Takuji
Department of Respirology, Chiba University Graduate School of Medicine, Chiba, JPN.
Department of Medical Education, Chiba University Graduate School of Medicine, Chiba, JPN.
Cureus. 2024 Apr 18;16(4):e58563. doi: 10.7759/cureus.58563. eCollection 2024 Apr.
Tube thoracostomy (TT) complications are common in respiratory medicine. However, the prevalence of complications and risk factors is unknown, and data on countermeasures are lacking.
This was a mixed-methods retrospective observational and qualitative study. This retrospective observational study included TT performed on patients admitted to the Department of Respiratory Medicine at our University Hospital between January 1, 2019, and August 31, 2022 (n=169). The primary endpoint was the incidence of TT-related complications. We reviewed the association between complications and patient- and medical-related factors as secondary endpoints. In this qualitative study, we theorized the background of physicians' susceptibility to TT-related complications based on the grounded theory approach.
Complications were observed in 20 (11.8%) of the 169 procedures; however, they were unrelated to 30-day mortality. Poor activities of daily living (odds ratio 4.3, p=0.007) and regular administration of oral steroids (odds ratio 3.1, p=0.025) were identified as patient-related risk factors. Physicians undergoing training caused the most complications, and the absence of a senior physician at the procedure site (odds ratio 3.5, p=0.031) was identified as a medical risk factor. Based on this qualitative study, we developed a new model for TT complication rates consistent with the relationship between physicians' professional skills, professional identity, and work environments.
Complications associated with TT are common. Therefore, it is necessary to implement measures similar to those identified in this study. Particularly, a supportive environment should be established for the training of physicians.
胸腔闭式引流术（TT）并发症在呼吸医学中很常见。然而，并发症的发生率和风险因素尚不清楚，且缺乏应对措施的数据。
这是一项混合方法的回顾性观察和定性研究。这项回顾性观察研究纳入了2019年1月1日至2022年8月31日期间在我校附属医院呼吸内科住院患者中进行的TT操作（n = 169）。主要终点是TT相关并发症的发生率。我们将并发症与患者及医疗相关因素之间的关联作为次要终点进行了回顾。在这项定性研究中，我们基于扎根理论方法对医生易发生TT相关并发症的背景进行了理论分析。
169例操作中有20例（11.8%）观察到并发症；然而，它们与30天死亡率无关。日常生活活动能力差（比值比4.3，p = 0.007）和规律服用口服类固醇（比值比3.1，p = 0.025）被确定为患者相关风险因素。接受培训的医生导致的并发症最多，操作现场没有上级医生（比值比3.5，p = 0.031）被确定为医疗风险因素。基于这项定性研究，我们开发了一个与医生专业技能、职业认同和工作环境之间关系相一致的TT并发症发生率新模型。
与TT相关的并发症很常见。因此，有必要实施与本研究中确定的措施类似的措施。特别是，应为医生培训建立一个支持性环境。
