Review of patients discharged post thoracic surgery with chest drain in situ and nurse-based follow-up clinic.

Abstract

Persistent air leaks and prolonged drainage are recognized complications of thoracic surgery, increasing hospital stay and costs. Patients can be discharged with a chest drain and followed up in a nurse-led clinic. We reviewed such patients and the rate of readmission after discharge to assess the effectiveness of the drain follow-up clinic. We conducted a retrospective review of our prospective database spanning 22 months, from March 2019 to January 2021. The analysis focused on the indication and duration of chest drainage, complications, and readmission for any reason. 62 patients (representing 5% of all thoracic surgery patients) were discharged with a chest drain. The median age was 67 years (range 22-85 years), with 24 females and 38 males. 52% underwent video-assisted thoracoscopic surgery, 27% had a thoracotomy, and 21% had bedside chest drain insertion. Following discharge, the median duration of chest drainage was 11 days [interquartile range (IQR) 7-18.75 days]. Patients had 106 review episodes in the ward-based nurse-led clinic. The indications were prolonged air leak (71%; 72 clinic reviews), persistent fluid drainage following empyema evacuation (16%; 24 clinic reviews), and persistent fluid drainage for simple effusion (13%; 10 clinic reviews). The median length of drain stay was 30 days (IQR 19.75-54 days) for empyema, 10 days (IQR 6-16 days) for air leak, and 8 days (IQR 6.5-12 days) for simple effusion. 9 patients required readmission (14.5%), and empyema had developed in 3 patients (4.8%). Patients discharged with a chest drain in place can be followed up in a dedicated ward-based nurse-led monitoring clinic for optimal quality of care.