Influence of timing of chest tube removal on early outcome of patients underwent lung resection

Objective The presence of a chest tube is a factor significantly associated with postoperative pain and functional limitation in patients submitted to pulmonary resection. Our aim was to study if early removal of the chest tube is the better way that can effectively release pain, and improve pulmonary functions without increasing the risk of postoperative complications. Methods A prospective observational study was carried out on 88 patients who underwent lung resection by posterolateral thoracotomy. A single chest tube was inserted. Criteria for chest tubes removal were when air leak resolved and the fluid drainage was 350 ml/day or less provided that the drained fluid was macroscopically non-chylous and non-hemorrhagic. Static and dynamic pain scores and forced expiratory volume in the first second (FEV1) were assessed 2 h before and after the chest tube removal. The pain level was assessed by the numeric rating scale (NRS). Two measurements for FEV1 were performed both before and after the chest tube removal, and the best value measured at each time was recorded and used for the analysis. Postoperative complications were reported. Results The mean static and dynamic pain scores were decreased significantly after chest tube removal. The mean value of FEV1/Liters and FEV1% of predicted also showed statistically significant improvement after chest tube removal. 8 (9%) of patients developed pleural effusion. 5 (5.7%) of patients developed pneumothorax. Empyema was reported in 3 (3.4%) of patients. Conclusion Early removal of chest tube may have beneficial effect on control of post-thoracotomy pain, improvement of pulmonary functions and decreasing the risk of complications after lung resection.