Early chest tube removal regardless of drainage volume after anatomic pulmonary resection: A multicenter, randomized, controlled trial.

Objectives: This study aimed to evaluate the safety and feasibility of early chest tube removal after anatomic pulmonary resection, regardless of the drainage volume.
Methods: We conducted a multicenter, randomized, controlled, noninferiority trial. Patients with greater than 300 mL drainage volume during postoperative day 1 were randomly assigned to group A (tube removed on postoperative day 2) and group B (tube retained until drainage volume ≤300 mL/24 hours). The primary end point was the frequency of respiratory-related adverse events (grade 2 or higher based on the Clavien-Dindo classification) within 30 days postoperatively.
Results: Between April 2019 and October 2021, 175 patients were assigned to group A (N = 88) or group B (N = 87). One patient in group B who experienced chylothorax was excluded from the study. Respiratory-related adverse events were observed in 10 patients (11.4%) in group A and 12 patients (14.0%) in group B (P = .008). The frequencies of thoracentesis or chest tube reinsertion were not significantly different (8.0% and 9.3% in groups A and B, respectively, P = .752). Additionally, the duration of chest tube placement was significantly shorter in group A than in group B (median, 2 vs 3 days; P < .001). No significant difference between groups A and B was found in postoperative hospital stay (median, 6 vs 7 days, P = .231).
Conclusions: Early chest tube removal, regardless of drainage volume, was safe and feasible in patients who underwent anatomic pulmonary resection.
Competing Interests: Conflict of Interest Statement K.T.: honoraria from AstraZeneca, Chugai, Ono, Nippon Kayaku, Johnson & Johnson, and Covidien. T.H.: payment or honoraria from Intuitive Surgical and Johnson and Johnson. M.T.: payment or honoraria Johnson & Johnson Japan, AstraZeneca KK, Eli Lilly Japan, Chugai Pharmaceutical Co, Ltd, Taiho Pharma, Medtronic Japan, Ono Pharmaceutical Co, Ltd, MSD, Bristol-Myers Squibb KK, and Novartis. N.O.: payment or honoraria from Johnson & Johnson. N.I.: payment or honoraria from Taiho Pharma, Bristol Myers, Chugai Pharma, Fuji Film Nihon Mediphysics, MSD, Daiichi-Sankyo, Boehringer Ingelheim, Shionogi, Medtronic, Johnson & Johnson, Olympus, Roche, and Ono Pharma. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
(Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)