Elsevier

The Annals of Thoracic Surgery

Volume 66, Issue 5, November 1998, Pages 1751-1754
The Annals of Thoracic Surgery

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

Presented at the Poster Session of the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.
https://doi.org/10.1016/S0003-4975(98)00946-1Get rights and content

Abstract

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.

Section snippets

Methods

From December 1995 to July 1997, 59 patients underwent VATS wedge resection for indeterminate pulmonary nodules or interstitial lung disease. No further resection was used for these patients. A diagnosis of benign or malignant disease was determined with an intraoperative frozen section. Metastatic lesions or limited cardiopulmonary reserve precluded anatomic resection in those patients with malignant disease. Among the last 33 patients, we prospectively evaluated ER for chest tube management

Results

Ninety-four percent (31 of 33) of patients considered for ER met criteria for early tube removal (an intent to treat). An air leak and excessive chest tube drainage prohibited early removal in 2 patients. Both of these patients who were considered for ER had undergone VATS wedge resection of pulmonary parenchymal nodules.

Chest tube duration among the patients undergoing TM of their chest tubes averaged 3.3 days. Chest tubes were maintained an average of 1.8 days on suction and 1.3 days of water

Comment

A surgical procedure is often indicated for the diagnosis of an indeterminate pulmonary nodule and to assist in directing medical therapy for patients with interstitial lung disease. Video-assisted thoracoscopic surgery has become an important tool in this setting 9, 10. Although the cost-effectiveness of VATS has been debated 11, 12, the safety and efficacy have been established 3, 8, 10. Until the development of the thoracoscopic wedge resection technique, most diagnostic lung biopsies were

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