title: Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output.
abstract: OBJECTIVE
  Many patients have their hospital discharge delayed because their chest tube drainage is too high, despite the fact that there are no data to support the commonly used 250 mL/day threshold.
  
  
  METHODS
  A retrospective cohort study was conducted with a prospective database and prospective algorithm from one surgeon. All patients underwent elective pulmonary resection. The last chest tube was removed if there was no air leak and nonchylous drainage of 450 mL/day or less.
  
  
  RESULTS
  The study comprised 8608 operations and 2077 patients who underwent an elective (nonpneumonectomy) pulmonary resection via thoracotomy by one general thoracic surgeon over a 10-year period. Eighty-nine patients went home with a chest tube owing to air leak. The remaining 1988 patients were discharged without a chest tube. Types of pulmonary resection were wedge resection in 729 patients, segmentectomy in 214, lobectomy in 1104, and bilobectomy in 30. The median day of discharge was postoperative day 4. One hundred one (5%) were readmitted to the hospital within 60 days of discharge. The most common reason for readmission was dehydration and fatigue. Only 11 (0.55%) had readmissions owing to recurrent symptomatic effusion and most were treated with video-assisted thoracoscopy. Follow-up was 100% at 4 weeks and 93% at 8 weeks.
  
  
  CONCLUSIONS
  Chest tubes can be removed with up to 450 mL/day of nonchylous drainage after pulmonary resection, and perhaps a higher volume could be accepted. Readmission owing to a recurrent effusion is exceedingly uncommon, and the practice of leaving the tube in longer for drainage less than 450 mL/day is unsupported in the literature.
authors.affiliation: Section of Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala 35294, USA. Robert.cerfolio@ccc.uab.edu
authors.forename: Robert James
authors.initials: RJ
authors.lastname: Cerfolio
authors.forename: Ayesha S
authors.initials: AS
authors.lastname: Bryant
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015505:Chest Tubes; D020878:Device Removal; D004322:Drainage / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome