title: The single chest tube versus double chest tube application after pulmonary lobectomy: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Draining of the chest cavity with two chest tubes after pulmonary lobectomy is a common practice. The objective of this study was to evaluate whether using two tubes after a pulmonary lobectomy is more effective than using a single tube.
  
  
  METHODS
  We performed a meta-analysis of five randomized studies that compared the single chest tube with double chest tube application after pulmonary lobectomy. The primary end-point was amount of drainage and duration of chest tube drainage. The secondary end-points were the patient's numbers of new drain insertion after operation, hospital stay after operation, the patient's numbers of subcutaneous emphysema after operation, the patient's numbers of residual pleural air space, pain score, the number of patients who need thoracentesis, and cost.
  
  
  RESULTS
  Five randomized controlled trials totaling 502 patients were included. Meta-analysis results are as follows: There were statistically significant differences in amount of drainage (risk ratio [RR] = -0.15; 95% confidence interval [CI] = -3.17, -0.12, P = 0. 03), duration of chest tube drainage (RR = -0.43; 95% CI = -0.57, -0.19, P = 0.02), pain score (P < 0.05). Compared with patients receiving the double chest tube group, there were no statistically significant differences between the two groups with regard to the patient's numbers of new drain insertion after operation.
  
  
  CONCLUSIONS
  Compared with the double chest tube, the single chest tube significantly decreases amount of drainage, duration of chest tube drainage, pain score, the number of patients who need thoracentesis, and cost. Although there is convincing evidence to confirm the results mentioned herein, they still need to be confirmed by large-sample, multicenter, randomized, controlled trials.
authors.affiliation: Department of Thoracic Surgery, The Second Hospital of Dalian Medical University, Dalian 116023, China.
authors.forename: Xuefei
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, The Second Hospital of Dalian Medical University, Dalian 116023, China.
authors.forename: Desheng
authors.initials: D
authors.lastname: Lv
authors.affiliation: Department of Thoracic Surgery, The Second Hospital of Dalian Medical University, Dalian 116023, China.
authors.forename: Mo
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Thoracic Surgery, The Second Hospital of Dalian Medical University, Dalian 116023, China.
authors.forename: Ge
authors.initials: G
authors.lastname: Sun
authors.affiliation: Department of Thoracic Surgery, The Second Hospital of Dalian Medical University, Dalian 116023, China.
authors.forename: Changhong
authors.initials: C
authors.lastname: Liu
mesh_terms: D015505:Chest Tubes; D004322:Drainage / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D019233:Retreatment; D016896:Treatment Outcome