title: Safety of Outpatient Chest Tube Management of Air Leaks After Pulmonary Resection.
abstract: Prolonged air leaks are the most common postoperative complication following pulmonary resection, leading to increased hospital length of stay (LOS) and cost. This study assesses the safety of discharging patients home with a chest tube (CT) after pulmonary resection. A retrospective review was performed of a single surgeon's experience with pulmonary resections from January 2010 to January 2015. All patients discharged home with a CT were included. Discharge criteria included a persistent air leak controlled by water seal, resolution of medical conditions requiring hospitalization, and pain managed by oral analgesics. Patient demographics, type of resection, LOS, and 30-day morbidity and mortality data were analyzed. Comparisons were made with the Society of Thoracic Surgery database January 2011 to December 2013. Four hundred ninety-six patients underwent pulmonary resection. Sixty-five patients (13%) were discharged home postoperatively with a CT. Fifty-eight patients underwent a lobectomy, two patients a bilobectomy, and five patients had a wedge excision. Two patients were readmitted: One with a lower extremity deep venous thrombosis and the other with a nonlife threatening pulmonary embolus. Four patients developed superficial CT site infections that resolved after oral antibiotics. Patients discharged home with a CT following lobectomy had a shorter mean LOS compared to lobectomy patients (3.65 vs 6.2 days). Mean time to CT removal after discharge was 4.7 days (range 1-22 days) potentially saving 305 inpatient hospital days. Select patients can be discharged home with a CT with reduced postoperative LOS and without increase in major morbidity or mortality.
authors.affiliation: Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee, USA.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Royer
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Smith
authors.forename: Ashley
authors.initials: A
authors.lastname: Miller
authors.forename: Marlana
authors.initials: M
authors.lastname: Spiva
authors.forename: Jenny M
authors.initials: JM
authors.lastname: Holcombe
authors.forename: James R
authors.initials: JR
authors.lastname: Headrick
mesh_terms: D000328:Adult; D000368:Aged; D000388:Air; D000553:Ambulatory Care / Q000379:methods*; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D015505:Chest Tubes; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000639:trends*; D016208:Databases, Factual; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D061214:Patient Safety; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome