A Retrospective Case-control Study Between Early Chest Tube Removal And Postoperative Complications,Especially Thoracentesis

1.Objectives:In VATS(video-assisted thoracic surgery),the indication of patients with chest tube removal is generally controlled by different doctors’ experience.This has caused many patients to prolong their hospital stay due to excessive daily drainage after surgery and causes specific physical and psychological trauma.This study intends to verify the relationship between drainage and postoperative complications and find the relationship between the volume and time when the chest tube is removed to limit the patient’s pain and early recovery.2.Methods:A case-control study was performed from Jan 2018 to Sep 2020,and a total of 234 patients who underwent VATS in our hospital by the same surgical team were enrolled.All patients did not complicate by air leakage or bloody,chylous pleural effusion.Data included age,gender,surgical approach(segmentectomy,lobectomy),pathological stage T1 and T2,smoking state,the number of chest tube placed,postoperative day(POD)of chest tube removal(Day 1,2,3,and ≥4,respectively)and drainage volume(ml/day)on the day of chest tube removal.Patients who underwent wedge resection,bi-lobectomy,and who received radio-chemotherapy,had previous lung surgery performed on the same side,and had a bleeding risk during the perioperative period were excluded.3.Results:Pleural effusion after chest tube removal required reintervention(thoracentesis)in 30patients(12.8%);none of them were readmitted,4 of 234 suffered cerebral infarction and prolonged removal time.The median time from surgery to chest tube removal was three days,and the median time from surgery to discharge was five days.A statistically significant association was found between the time of chest tube removal and patients’ smoking state,the number of chest tubes placed,and surgical approach(P<0.05).And there is also a statistically significant difference between chest tube removal after POD3 and patients’ need thoracentesis(p<0.05).It is further found that for patients who meet certain conditions(no smoking,double chest tube placed),even if the drainage volume is larger than 200ml/day on removal,they can be removed early on POD2,3 without increasing the incidence of thoracentesis.4.Conclusions:Our findings suggest that chest tube removal after VATS segmentectomy or lobectomy in patients meeting certain conditions is safe despite volumes of serous fluid production more than 200ml/day and without increasing the incidence of complications.Meantime,it can also reduce patients’ suffering with tube intolerance and enhance their recovery,limit their physical and psychological burdens,and admit time and medical resource consumption.It is in line with the concept of modern evidence-based medicine for enhanced recovery after surgery(ERAS).