DOI: 10.5061/dryad.v15dv41t6
title: Safety of the anterior approach versus the lateral approach for chest tube insertion by residents treating spontaneous pneumothorax: a propensity score weighted analysis

description: Background: Chest tube malposition is the most common complication during
 chest tube insertion. This study aimed to compare the risk of chest tube
 malposition between the anterior and lateral approaches for thoracostomy
 performed by junior and senior residents. Methods: This retrospective
 study 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. The study exposure
 involved the 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 malpositioned chest
 tubes. Multiple imputation was used for missing data. The propensity score
 within each imputed dataset was calculated by using the collected
 variables. The inverse probability of treatment weighting (IPTW) method
 was used to adjust for baseline confounders. Results: IPTW analysis
 revealed that the estimated odds ratio for chest tube malposition in the
 anterior approach group (n = 34) versus the lateral approach group (n =
 219) was 0.61 (95% confidence interval, 0.17–2.11). Conclusion: In
 patients treated for primary or secondary pneumothorax by junior or senior
 residents, the risk of chest tube malposition was not significantly
 different between the anterior and lateral approach for thoracostomy.
description: This retrospective cohort study was conducted between November
 2018 and March 2019 at Kameda Medical Center. The study included patients
 aged ≥ 20 years who were diagnosed with primary or secondary spontaneous
 non-tension pneumothorax without pleural adhesions and underwent chest
 thoracostomy performed by junior (postgraduate years 1–2) or senior
 (postgraduate years 3–5) residents between April 2001 and February 2019.
 Plain chest radiographs or CT images acquired before thoracostomy were
 independently evaluated by two senior pulmonology residents (AS and YT),
 who determined the presence or absence of pleural adhesions. The residents
 excluded patients via consensus if thoracostomy could be performed only by
 the anterior approach or the lateral approach because of dense pleural
 adhesions. Patients were also excluded if they were judged to have
 pneumothorax under mechanical ventilation or required concomitant fluid
 drainage before thoracotomy. The patients’ medical records provided data
 on the patients’ background, insertion site, and clinical course during
 hospitalization. Junior and senior residents performed
 thoracostomy under the supervision of attending doctors. The study
 exposure, which involved chest tube insertion via the anterior route
 (interspace between the first and second ribs or the second and third ribs
 in the midclavicular line) or the lateral route (interspace between the
 fourth and fifth ribs in the anterior axillary line or midaxillary line),
 was determined at the discretion of the attending physician. Chest tubes
 were inserted anteriorly or laterally at the discretion of the attending
 physician. The number of chest tube malpositions
 reported in the medical records was assessed as the primary outcome. Chest
 tube malposition was defined as clinical evidence of chest tube
 malfunction or failure to place the chest tube between the visceral and
 parietal pleural space. Malposition included lung parenchymal,
 mediastinal, intrafissural, intraparenchymal, or subcutaneous insertion of
 a chest tube, necessitating further improvements in its position or the
 insertion of another drainage tube. 
description: This dataset includes variables needed for the statistical
 analaysis of the primary outcome, the number of chest tube malposition.
 Variables are id (anonymized patient's ID), age, gender (0: female,
 1: male), weight (kg), height (cm), place (place where chest tube was
 inserted, 0: emergency room, 1: clinic, 2: inhospital setting), department
 (attending doctors' department, 0: emergency department, 1:
 department of pulmonology, 2: department of thoracic surgery),
 patients' medical history (copd: chronic obstructive pulmonary
 disease, ild: interstitital lung disease, cancer: lung cancer or lung
 metastases of other type of cancer), bronchiectasis),
 midclavicular_approach (0: chest tube insertion laterally, 1:chest tube
 insertion anteriorly), death (0: not, 1: inhospital death), malposition
 (0:not, 1:malposition).