[Early chest tube removal after video-assisted thoracoscopic surgery. Results of a prospective randomized study].
BACKGROUND
Chest tubes frequently cause postoperative patient discomfort after video-assisted thoracoscopic surgery (VATS). Therefore, a prospective randomized study was conducted to analyze whether early chest tube removal within 2 h postoperatively is justified in VATS.


METHODS
Ninety-three patients fulfilled the inclusion criteria (VATS including wedge resection, complete lung extension on postoperative chest roentgenogram) and showed no exclusion criteria (lung volume reduction surgery, extensive pulmonary fibrosis, pneumothorax, pleural effusion, air fistula). Randomization resulted in early chest tube removal in 48 patients and in conventional chest tube management in 45 patients.


RESULTS
Pain intensity was significantly reduced after early chest tube removal (P=0.03, t-test). In consequence, the mean analgesic requirement was significantly reduced (P=0.0001, t-test). The number of postoperative chest roentgenograms was significantly reduced after early chest tube removal (P=0.0001, t-test). The mean postoperative length of hospital stay was 5.4 vs 6.7 days (P=0.11, t-test). No postoperative complication occurred after early chest tube removal, while postoperative complications were observed in six patients with conventional chest tube management (P=0.01, Fisher's test).


CONCLUSIONS
Early chest tube removal after video-assisted thoracoscopic wedge resection is recommended. The inclusion and exclusion criteria of this study should be considered for future early chest tube removal. Long-term follow-up will clarify if early chest tube removal also leads to a reduction in chronic pain.
Sienel
W
W
Abteilung Thoraxchirurgie, Chirurgische Universitätsklinik Freiburg. wulf.sienel@uniklinik-freiburg.de
Mueller
J
J
Eggeling
S
S
Thetter
O
O
Passlick
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D003627:Data Interpretation, Statistical; D004322:Drainage; D005260:Female; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy; D018579:Patient Selection; D010997:Pleural Neoplasms / Q000601:surgery; D011183:Postoperative Complications; D011446:Prospective Studies; D013902:Radiography, Thoracic; D020775:Thoracic Surgery, Video-Assisted; D013997:Time Factors