P3.04-031 Intermittent Chest Tube Clamping May Shorten Chest Tube Duration and Postoperative Hospital Stay of Lung Cancer Surgery: Topic: Miscellaneous II

Abstract

Postoperative pleural drainage markedly influences the length of postoperative hospital stay and financial costs of medical care. Previous report documented the safety of chest tube clamping before removal. This study aims to see if intermittent chest tube clamping might shorten tube duration and hospital stay of lung cancer surgery. From July 2012 to June 2016, 285 consecutive cases of operable lung cancer patients undergoing lobectomy and systematic mediastinal lymphadenectomy were retrospectively analyzed. Chest tube management protocol was modified since January 2014 according to the literature. Before that time, patients (Group control, n=63) were managed with gravity drainage (water seal only and without suction). After that, patients (Group clamping, n=222) were managed with gravity drainage during first 24 hours after surgery (water seal only and without suction). Once a radiograph confirmed the reexpansion of the lung and no air leak detected, the tube would then be clamped intermittently at 24 hours after surgery and nurses checked the patients every 6 hours. If no abnormal symptoms developed (such as severe dyspnea, pneumothorax, subcutaneous emphysema), then unclamped 30 minutes to record drainage volume every 24 hours. The tube would be removed if drainage was normal and its volume was less than 200 ml in both group. All clinical data were recorded. Propensity score matching at 1:1 ratio was applied to balance variables potentially affecting chest tube duration between Group Clamping and Group Control. Analyses were performed to compare chest tube duration and postoperative hospital stay between the two groups. Variables linked with chest tube duration were gender, operation side, VATS and chylothorax, which were assessed using multivariable logistic regression analysis in whole cohort. The rate of thoracocentesis after chest tube removal did not increase in Group Clamping compared with Group Control in whole cohort (0.5% vs. 1.5%, P=0.386). The rates of pyrexia were also comparable in two groups (2.3% vs. 3.2%, P=0.685). After propensity score matching, 61 cases remained in each group. Group Clamping showed shorter chest tube duration (4.0 days vs. 4.8 days, P=0.001) and shorter postoperative stay (5.7 days vs. 6.4 days, P=0.025) compared with Group Control. Factors significantly associated with shorter chest tube duration were being female, left lobectomy, chest tube clamping, VATS and absence of chylothorax (P<0.05). This study suggests that chest tube clamping may decrease the length of chest tube duration and postoperative hospital stay while maintaining patient safety.