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Results of an Algorithm to Remove Chest Tubes After Pulmonary Resection with High Output
R. J. Cerfolio, A. S. Bryant. University of Alabama at Birmingham, Birmingham, AL,
BACKGROUND: Many patients have their hospital discharge delayed because their chest tube drainage after pulmonary resection is too high, despite the fact that there is no data to support the commonly used 250 cc/day threshold.
METHODS: A retrospective study using a prospective database and prospective algorithm from one surgeon. All patients underwent elective pulmonary resection. The last chest tube was removed if there was no air leak and if the non-chylous drainage was 450 cc/day or less.
RESULTS:There were 4,164 patients (2,767 men) who underwent pulmonary resection via thoracotomy by one general thoracic surgeon between 1/2000 and 12/2006. Median age was 67 years. Types of pulmonary resection were wedge resection in 421, segmentectomy in 486, and lobe or bi-lobectomy in 880. One-hundred and ninety-six (4%) patients went home with a chest tube secondary to air leak. The remaining 3,968 patients were discharged without a chest tube. Median day of discharge was post-operative day 4 and 187 patients (4%) were readmitted to the hospital within 60 days. The most common reason for readmission was nausea and dehydration. Only 6 (<1%) had readmissions secondary to recurrent symptomatic effusion and of these 2 underwent video-assisted drainage. One patient had a chylothorax. Follow-up was complete in 3,872 patients (93%).
CONCLUSIONS: Chest tubes can be removed with at least 450 cc/day of drainage after pulmonary resection, and perhaps a higher volume could be accepted. Recidivism secondary to a recurrent effusion is exceedingly rare and the practice of leaving the tube in longer because of drainage less than 450 cc/day is unsupported.
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