The safe volume threshold for chest drain removal following pulmonary resection

Abstract

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'In patients undergoing pulmonary resection, is there a safe drainage volume threshold for chest drain removal?' Altogether 1054 papers were found, of which 5 papers represented the best evidence. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Chest drainage threshold, where used, ranged from 250 to 500 ml/day. Both randomized controlled trials showed no significant difference in reintervention rates with a higher chest drainage volume threshold. Four studies that performed analysis on other complications showed no statistical significant difference with a higher chest drainage volume threshold. Four studies evaluating length of hospital stay showed reduced or no difference in the length of stay with a higher chest drainage volume threshold. Two cohort studies reported the mortality rate of 0-0.01% with a higher chest drainage volume threshold. We conclude that early chest drain removal after pulmonary resection, accepting a higher chest drainage volume threshold of 250-500 ml/day is safe, and may result in shorter hospital stay without increasing reintervention, morbidity or mortality.

Feasibility analysis for the development of a video-assisted thoracoscopic (VATS) lobectomy 23-hour recovery pathway

“…Targets for chest tube removal are standardized in our ERP to a threshold of less than 300 mL of drainage in 24 hours with no evidence of air leak or chylothorax. 25 Since this ERP was implemented, several publications have reported safety with higher drainage thresholds, 33,34 and these have been implemented informally in our unit. Nonetheless, chest tube removal may have been delayed in a number of cases in this series because of an output greater than 300 mL in 24 hours.…”

“…Air leak is the most common postoperative complication of pulmonary resections and it is known to substantially increase LOS and health care costs. 33 Patients can, however, be safely discharged with portable draining systems, allowing this common complication to be managed on an outpatient basis. 36,36 Thus, introducing portable drainage systems that can be safely managed by the patient at home would constitute a substantial advantage in terms of increasing the proportion of patients discharged within 23 hours.…”