Lower incidence of late tamponade after cardiac surgery by extended chest tube drainage

Abstract

Objectives. To ascertain whether extended chest tube drainage decreases the occurrence of late tamponade after cardiac surgery. Design. All patients undergoing cardiac surgery at the Tampere University Heart Hospital, Tampere, Finland, between the 23rd of October 2015 and the 17th of August 2016 were included. The first 260 consecutive patients were treated according to a short drainage protocol, in which the mediastinal chest tubes were removed during the first postoperative day unless producing >50ml/h, and the following 224 consecutive patients by an extended drainage protocol, in which the mediastinal chest tubes were kept at least until the second postoperative day, and thereafter if producing >50ml/4h. The incidence of late tamponade and the length and course of postoperative hospitalization, including the development of complications, were compared. Results. The occurrence of late cardiac tamponade was 8.8% following the short drainage protocol and 3.6% after the extended drainage protocol, p = .018. There were no statistically significant differences in the demographics, medical history, or the procedures performed between the study groups. The in-hospital mortality rate was 3.5%, the stroke rate was 2.1%, and the deep sternal wound infection rate was 1.7%, with no statistically significant differences between the groups. There were no differences in the need for reoperations for bleeding, infection rate, need for pleurocentesis, occurrence of atrial fibrillation, or the length of hospitalization between the groups. Conclusions. Longer mediastinal chest tube drainage after cardiac surgery is associated with a significantly lower incidence of late cardiac tamponade.