Coaxial Drainage Versus Standard Chest Tube After Pulmonary Lobectomy: A Randomized Controlled Study

Abstract

Objectives: Chest tubes are routinely inserted after thoracic surgery procedures in different size and numbers. The aim of this study is to assess the efficacy of Smart Drain Coaxial drainage compared with two standard chest tubes in patients undergoing thoracotomy for pulmonary lobectomy.Methods: Ninety-eight patients (57 males and 41 females, mean age 68.3±7.4 years) with lung cancer undergoing open pulmonary lobectomy were randomized in two groups: 50 received one upper 28-Fr and one lower 32-Fr standard chest tube (ST group) and 48 received one 28-Fr Smart Drain Coaxial tube (SDC group). Hospitalization, quantity of fluid output, air leaks, radiograph findings, pain control and costs were assessed.Results: We performed 33 right upper lobectomies (17 ST, 16 SDC), 25 right lower (15 ST, 10 SDC), 20 left upper (8 ST, 12 SDC) and 19 left lower (10 ST, 9 SDC). SDC group showed shorter hospitalization (7.3 vs 6.1 days, p=0.02), lower pain in postoperative day-1 (p=0.02) and a lower use of analgesic drugs (p=0.04). Pleural effusion drainage was lower in SDC group in the first postoperative day (464±143 ml vs 408±141 ml, p=0.04) and regarding the average of the first three days (374±96 ml vs 324±95 ml, p=0.01). No difference in terms of fluid retention, residual pleural space, subcutaneous emphysema and complications after chest tubes removal was found. Conclusions: Smart Drain Coaxial chest tube seems a feasible option after thoracotomy for pulmonary lobectomy. The SDC group showed a shorter hospitalization and a decreased analgesic drugs use and, thus, a reduction of costs.