Abstract
Background: High chest tube drainage following lung surgery is a rate-limiting step to discharge, increasing length of hospital stay. There is a paucity of evidence-based clinical research on safe maximal daily chest tube drainage prior to removal. Objectives: To describe the practice patterns of Canadian thoracic surgeons with respect to daily chest tube drainage after routine pulmonary surgery. Methods: A self-reported electronic questionnaire was administered to members of the Canadian Association of Thoracic Surgeons (CATS). Data was tabulated on the primary outcome of acceptable maximal daily pleural output prior to chest tube removal, and secondary outcomes of: years in clinical practice, academic versus community setting and rational for chest tube management. Descriptive and univariate analysis was conducted for each response by maximal daily pleural drainage category. Results: A total of 124 surveys were distributed. Response rate was 56%, with a 93% completion rate. Acceptable maximal pleural drainage among surgeons was highly variable. Rationale for tube removal was also variable, including individual clinical experiences (n = 23, 33%), evidence based guidelines (n = 18, 26%), and group practice pattern (n = 12, 17%). Academic surgeons comprised 72% of respondents. Community based surgeons were more likely to remove tubes at a lower mean volume. Years in clinical practice did not influence acceptable daily pleural drainage. Conclusion: There is great variability in post-operative management of chest tube fluid output among Canadian thoracic surgeons. Future research on this topic is warranted, with the aim of developing an evidence-based chest tube management algorithm incorporating daily chest tube drainage volumes as a key variable.
Highlights
High chest tube drainage following lung surgery is a rate-limiting step to discharge, increasing length of hospital stay
Data was tabulated on the primary outcome of acceptable maximal daily pleural output prior to chest tube removal, and secondary outcomes of: years in clinical practice, academic versus community setting and rational for chest tube management
With no generally accepted protocol in place for management of higher volume pleural drainage, this study aims to determine exactly what daily pleural drainage volumes Canadian thoracic surgeons find acceptable to remove a chest tubes following routine lung resection
Summary
High chest tube drainage following lung surgery is a rate-limiting step to discharge, increasing length of hospital stay. Conclusion: There is great variability in post-operative management of chest tube fluid output among Canadian thoracic surgeons Future research on this topic is warranted, with the aim of developing an evidence-based chest tube management algorithm incorporating daily chest tube drainage volumes as a key variable. With respect to air leak management, there are numerous reported “fast-tracking” algorithms fit to appropriate patient scenarios These have shown to lead to shorter hospitalization, and lower overall costs without compromising standard of care. Chest tube drainage greater than 250 milliliters (ml) is a commonly cited reason by surgeons for delayed discharge [11] This practice may prolong hospital stay on average by two days, and is not evidence based [11] [12]. Increased length of stay can be extrapolated to higher healthcare costs, discomfort for the patient and increased risk of tube-related complications [11] [12] [16] [20]
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