Threshold for Safe Post-Operative Chest-Tube Removal in Cardiac Surgery

Objectives: Timing of chest tube removal is critical in post-cardiac surgery care. Early removal may lead to pleural and/or cardiac effusion requiring reinterventions and potential complications, while delayed removal can increase infection rates, exacerbate fluid accumulation, and prolong the postoperative length of stay (LOS). This study evaluated whether removing chest tubes at a drainage volume below 250 mL/day reduces complications without extending LOS.

Methods: A prospective, two-center study was conducted between May 2023 and May 2024. Each center applied a different chest tube removal protocol. In one center, tubes were removed at <250 mL/day (Group 1), while in the other, at >350 mL/day (Group 2). Outcomes included reintervention or 30-day rehospitalization rates due to recurrent pleural effusion and LOS in both groups.

Results: The study included 324 patients (162 in each group). Mean ages were 62.44 ± 9.19 years (Group 1) and 70.51 ± 4.63 years (Group 2). Reinterventions or 30-day rehospitalizations were significantly lower in Group 1 (10 patients) compared to Group 2 (31 patients) (p < 0.05). LOS was similar between groups: 8.48 ± 6.16 days and 8.66 ± 7.87 days respectively (p = 0.81).

Conclusions: Removing chest tubes at <250 mL/day significantly reduced reinterventions and rehospitalizations due to recurrent pleural effusion without prolonging the postoperative LOS, compared to removal at >350 mL/day. This protocol may reduce unnecessary and risky procedures, such as pleurocentesis or chest tube reinsertion. While further studies are needed, these findings provide important insights for optimizing post-operative chest tube management to improve patient outcomes and reduce complications.