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

Background. Traditional management of chest tubes after a wedge resection o f peripheral pulmonary tissue often lasts several days. We evaluated the sa fety and efficacy of early chest tube removal in the recovery room after un complicated video-assisted thoracoscopic surgical wedge resections of the l ung. Methods. From December 1995 to July 1997, 59 patients underwent video-assis ted thoracoscopic surgical wedge resection for indeterminate pulmonary nodu les (n = 33) or interstitial lung disease (n = 26). We prospectively evalua ted early chest tube removal in the last 33 patients; 18 patients with nodu les and 15 with interstitial lung disease. Patients who were in the early r emoval group had chest tubes removed within 90 minutes of the surgical proc edure. Criteria for early removal were established and met before chest tub e 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 ch est tube removal met criteria for immediate tube removal. Air leak and exce ssive drainage prohibited early removal in 2 patients. Patients who were ma naged 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 tube s 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 pneumo thoraces (5 in the early removal group, 7 in the traditional management gro up), 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 su rgical wedge resection of peripheral pulmonary tissue appears to be a safe and cost-effective practice if strict criteria for removal are met. (C) 199 8 by The Society of Thoracic Surgeons.