Safety of the anterior approach versus the lateral approach for chest tube insertion by residents treating spontaneous pneumothorax: a propensity score weighted analysis

Objective To compare the risk of chest tube malposition, the most common complication during chest tube insertion, with the anterior or lateral approach for thoracostomy performed for patients with spontaneous pneumothorax by junior and senior residents. Methods We retrospectively included patients aged ≥ 20 years who exhibited primary or secondary spontaneous pneumothorax without pleural adhesion and underwent chest tube drainage performed by junior or senior residents at tertiary care hospital. The study exposure involved insertion of the chest tube in the midclavicular line (anterior approach) or the anterior or midaxillary line (lateral approach). The primary outcome was the number of chest tube malpositions. Multiple imputation was used for missing data. The inverse probability of treatment weighting method was used to adjust for baseline confounders. Results We identified 34 and 219 patients who underwent thoracostomy using the midclavicular and lateral approaches, respectively. The number of chest tube malpositions was 4 (11.8%) in the anterior approach and 34 (15.5%) in the lateral approach. The inverse probability of treatment weighting analysis revealed that the estimated odds ratio for chest tube malposition in the anterior approach group versus the lateral approach group was 0.61 (95% confidence interval, 0.17–2.11). The duration of chest tube drainage and the number of operations for persistent air leaks were not significantly different between the groups. Conclusions The current study revealed that the risk of chest tube malposition in thoracostomies with the midclavicular approach was not different from that with the lateral approach.