Use of a Trauma Service Clinical Pathway to Improve Patient Outcomes for Retained Traumatic Hemothorax

Early evacuation of retained hemothorax (RHTX) has been shown to improve clinical outcomes. In 2006, our trauma surgery service instituted a clinical pathway for management of RHTX that was designed to decrease time to operation and improve patient outcomes. We report our experience with early evacuation of posttraumatic RHTX after instituting a service-wide clinical pathway. From 2006 to 2007, 29 operations were performed by the trauma surgery service for RHTX. Using the clinical pathway, if patients had a persistent effusion on hospital day 2, the patient underwent thoracoscopic (VATS) evacuation of the hemothorax. A case control cohort (24 patients) was generated from 2003 to 2005 of operations for retained hemothorax before implementation of this pathway. The mean age was 33.2 years. There was no difference in ISS between groups (p = 0.14). The study group had significantly decreased time to operating room (3.0 +/- A 0.33 days vs. 9.9 +/- A 2.0 days, P = 0.002) and shorter hospital stays (10.8 +/- A 0.8 days vs. 30.5 +/- A 5.8 days, P = 0.003). All 29 study patients had their hemothorax evacuated by VATS, whereas 14 of 29 control patients had evacuation attempted by VATS (P = 0.0003). There were no differences in complications or reoperation between groups. Total hospital charges for the study group were $46,471 in the study group compared with $126,221 in the control group (P = 0.03). Implementation of a clinical pathway for early evacuation of retained hemothorax can significantly improve patient outcomes and decrease hospital costs. Furthermore, trauma surgeons are capable of safely performing thoracic surgery for evacuation of retained hemothorax.