title: Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day.
abstract: OBJECTIVE
  In fast-track pulmonary resections, we removed chest tubes after video-assisted thoracic surgery (VATS) lobectomy with serous fluid production up to 500 ml/day. Subsequently, we evaluated the frequency of recurrent pleural effusions requiring reintervention.
  
  
  METHODS
  Data from 622 consecutive patients undergoing VATS lobectomy from January 2009 to December 2011 were registered prospectively in an institutional database. Data included age, gender, lobe(s) resected, bleeding and duration of surgery. Follow-up was 30 days from discharge. All complications requiring pleurocentesis or reinsertion of a chest tube, and all readmissions were registered. Twenty-three patients were excluded due to missing data, in-hospital mortality and loss to follow-up, leaving 599 for final analysis. Our primary outcome was the number of patients requiring reintervention due to recurrent pleural effusion. Secondary outcomes included time of chest tube removal and time to discharge. The incidence of recurrent pleural effusions requiring reintervention was compared between three groups according to the postoperative day (POD) of chest tube removal (Day 0-1, 2-3 and ≥4, respectively) using Fisher's exact test.
  
  
  RESULTS
  Pleural effusion after chest tube removal required reintervention in 17 patients (2.8%). Of these, 7 needed readmission. Median time from surgery to chest tube removal was 2 days, and median time from surgery to discharge was 4 days. No statistically significant association was found between the incidence of reinterventions due to recurrent pleural effusion and the POD of chest tube removal (P=0.50). The median time from chest tube removal to discharge was 1 day in all groups. Of the patients who needed reintervention, none had complications regarding this, except one who developed pneumothorax after pleurocentesis.
  
  
  CONCLUSIONS
  Our findings suggest that chest tube removal after VATS lobectomy is safe despite volumes of serous fluid production up to 500 ml/day. The proportion of patients who developed pleural effusion necessitating reintervention was low (2.8%), and a complication of the reintervention was seen in only 1 patient.
authors.affiliation: Department of Cardiothoracic Anaesthesia and Section for Surgical pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lars S
authors.initials: LS
authors.lastname: Bjerregaard
authors.forename: Katrine
authors.initials: K
authors.lastname: Jensen
authors.forename: Rene Horsleben
authors.initials: RH
authors.lastname: Petersen
authors.forename: Henrik Jessen
authors.initials: HJ
authors.lastname: Hansen
mesh_terms: D000368:Aged; D015505:Chest Tubes; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology*; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Chest tube; Fast-track surgery; Lobectomy; Pleural effusion; Video-assisted thoracic surgery