Early chest tube removal after video-assisted thoracoscopic wedge resection of the lung. 

Russo L, Wiechmann RJ, Magovern JA, Szydlowski GW, Mack MJ, Naunheim KS, Landreneau RJ

BACKGROUND: Traditional management of chest tubes after a wedge resection of peripheral pulmonary tissue often lasts several days. We evaluated the safety and efficacy of early chest tube removal in the recovery room after uncomplicated video-assisted thoracoscopic surgical wedge resections of the lung. 
METHODS: From December 1995 to July 1997, 59 patients underwent video-assisted thoracoscopic surgical wedge resection for indeterminate pulmonary nodules (n =
33) or interstitial lung disease (n = 26). We prospectively evaluated early chest tube removal in the last 33 patients; 18 patients with nodules and 15 with interstitial lung disease. Patients who were in the early removal group had chest tubes removed within 90 minutes of the surgical
procedure. Criteria for early removal were established and met before chest tube removal. There was no difference between groups with respect to age, sex, comorbidities, or pathologic evaluation of resection specimens. 
RESULTS: Ninety-four percent (31 of 33) of patients
considered for early chest tube removal met criteria for immediate tube removal. Air leak and excessive drainage prohibited early removal in 2 patients. Patients who were managed traditionally averaged 3.3 days with chest tubes--1.8 days on suction, 1.3 days on water seal.
Patients who had early removal of their chest tubes had a shorter postoperative stay (2.0+/-1.0 versus 3.9+/-2.1 days, p = 0.001) and fewer chest roentgenograms (2.8+/-2.1 versus 5.1+/-2.0, p = 0.001). There were no differences in complications including small pneumothoraces (5 in the early removal group, 7 in the traditional management group), which were managed with
observation alone. Total narcotic requirements were greater in the traditional management group (54+/-44.8 versus 24.6+/-22.9 morphine milligram equivalents, p = 0.005). 
CONCLUSIONS: Early chest tube removal after video-assisted thoracoscopic surgical wedge resection of
peripheral pulmonary tissue appears to be a safe and cost-effective practice if strict criteria for removal are met.

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