A Trend Toward More Pigtails and Less Chest Tubes With Similar Outcomes

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Journal of the American College of Surgeons





Classically, chest tubes (CT) (28-40F) are used using an open cut-down technique for pneumo or hemothorax in trauma. Pigtails catheters (PC) inserted percutaneously, using Seldinger technique, can be an alternative as prior studies demonstrate effectiveness, but with decreased pain and morbidity.


This retrospective study using an institutional trauma registry includes all adult patients (age > 15) who required tube thoracostomy for hemothorax, pneumothorax and/or hemopnuemothorax from 2015-2020. The primary outcome studied was need for repeat intervention (requirement for additional tube thoracostomy, and operative intervention). PC were placed by the trauma surgeons and the reason for the use of PC was based on attending preference.


Over the five years 375 patients were identified as needing tube thoracostomy. 136 (36%) patients that had placement of PC vs 239 (64%) patients having CT placed. The frequency of PC increased significantly from 16.2% in 2015 to 62.3% in 2020. The need for additional intervention was 18% (25/136) in the PC group vs 28% (26/239) in the CT (p=0.1). Repeat intervention was similar for additional CT (15% vs 16%) and the need for video assisted thoracotomy (5% vs 10%). The need for thoracotomy was lower in the PC group (0 vs 10%, p < 0.01).


PC usage increased over the study period and had similar outcomes to CT with respect to need for further interventions, including additional tube thoracostomy placement, and operative intervention. Pigtails are an effective and safe alternative to chest tubes in select groups of thoracic trauma patients.