It is safe and feasible to omit the chest tube postoperatively for selected patients receiving thoracoscopic pulmonary resection: a meta-analysis

Li, Pengfei; Shen, Cheng; Wu, Yanming; Lai, Yutian; Zhou, Kun; Che, Guowei

doi:10.21037/jtd.2018.04.75

Cited by 12 publications

(13 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…9 Interestingly, there is also evidence suggesting the safety of avoiding any chest drain in selected patients undergoing minimally invasive surgery, showing better pain control and no difference in 30-day morbidity. 10…”

Section: Discussionmentioning

confidence: 99%

Single Chest Drain Practice Reduces Discharge Opioid Prescriptions in Thoracic Surgery

Zorrilla-Vaca

Feldman

Antonoff

et al. 2021

Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Introduction Chest drains are placed following pulmonary resection to promote lung re-expansion. The superiority of two chest drains at preventing postoperative complications has not been established, and practice remains largely dictated by surgeon preference. We sought to compare patient outcomes based on number of chest drains used. Methods This is a retrospective analysis including patients undergoing lobectomies and segmentectomies between March 2016 and April 2020. Patients were categorized based on number of chest drains placed and were matched 1:1 using the nearest neighbor (greedy) technique. Our primary outcome was opioid prescriptions at discharge (in morphine equivalent daily dose [MEDD]). Associations were tested using multilevel mixed-effects regression to account for variability between surgeons. Results A total of 1,094 patients met inclusion criteria. Single chest drain was used in 922 patients, whereas 172 had two chest tubes. After matching, there were 111 patients in each group. In multilevel mixed-effects logistic regression, patients treated with a single chest drain received fewer opioid prescriptions (β: −194 MEDD, 95% confidence interval [CI]: −302 to −86 MEDD, p < 0.01), were more likely to be opioid-free at hospital discharge (odds ratio [OR] = 2.11, 95% CI: 1.08–4.12, p = 0.03), and had lower readmission rates within 30 days (OR = 0.33, 95% CI: 0.13–0.84, p = 0.02). Single chest drain practice did not affect the risk of pulmonary complications and there was no statistically significant difference in length of hospital stay (3 days [interquartile range: 2–5] vs. 4 days [3–6], p = 0.08). Conclusion Single chest drain practice in lobectomies and segmentectomies was associated with less opioid prescription requirement without any increase in complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Single Chest Drain Practice Reduces Discharge Opioid Prescriptions in Thoracic Surgery

Zorrilla-Vaca

Feldman

Antonoff

et al. 2021

Thorac Cardiovasc Surg

View full text Add to dashboard Cite

show abstract

“…A meta-analysis of nine studies, including 918 patients undergoing pulmonary resection by VATS, found that approximately 50% of patients did not have a chest tube inserted. In these patients, postoperative pain scores and LOS were significantly reduced, compared with patients who had a chest tube inserted, with no difference in 30-day morbidity or re-intervention rates between the two groups (Li et al 2018 ). These findings suggest that omitting the chest tube is safe and feasible in selected patients.…”

Section: Postoperative Carementioning

confidence: 99%

Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care

et al. 2020

View full text Add to dashboard Cite

Introduction Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously updated guidelines for perioperative care in these patients. Methods A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, was established to develop recommendations for anesthesia practice in patients undergoing elective lung resection for lung cancer. The project addressed three key areas: preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventive Services Task Force criteria. Results Recommendations for intraoperative care focus on airway management, and monitoring of vital signs, hemodynamics, blood gases, neuromuscular blockade, and depth of anesthesia. Recommendations for postoperative care focus on the provision of multimodal analgesia, intensive care unit (ICU) care, and specific measures such as chest drainage, mobilization, noninvasive ventilation, and atrial fibrillation prophylaxis. Conclusions These recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.

show abstract

“…However, high-level evidence from randomised controlled trials is scarce. One systematic review (18) published in 2010 including one randomized controlled trial (RCT) (19) and three observational studies (20)(21)(22), and another with meta-analysis (23) of nine observational studies (20,(24)(25)(26)(27)(28)(29)(30)(31) was published in 2018. Subsequently, additional three RCTs (32)(33)(34) and six observational studies (35)(36)(37)(38)(39)(40) were published.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of omitting chest drains after video-assisted thoracoscopic surgery: a systematic review and meta-analysis

Huang¹,

Kehlet²,

Holbek³

et al. 2021

J Thorac Dis

View full text Add to dashboard Cite

Background: The aim of this systematic review and meta-analysis was to determine the efficacy and safety of omitting chest drains compared to routine chest drain placement after video-assisted thoracoscopic surgery (VATS). Methods: Five bibliographic databases, ClinicalTrials.gov and PROSPERO were comprehensively searched from inception to July 29, 2020 (no language restrictions). Postoperative outcomes were extracted and synthesized complying with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Risk of bias (RoB) including non-reporting bias, heterogeneity, and sensitivity were assessed.Subgroup analyses were performed based on study design. Results: Of 7,166 identified studies, 10 studies [four randomized controlled trials (RCTs) and six non-RCTs] with 1,079 patients were included. There were 561 patients in the no chest drain group (NCD) and 518 patients in the standard chest drain group (CD). In pairwise analysis the NCD group had significant shorter length of stay (LOS) [weighted mean difference (WMD) −1.53 days, P<0.001], less postoperative pain scores (WMD −1.09, P=0.002), but higher risk of drain insertion or thoracocentesis [risk radio (RR) 3.02, P=0.040]. There were no significant differences on the incidence of minor pneumothorax (RR 1.77, P=0.128), minor pleural effusion (RR 1.88, P=0.219), minor subcutaneous emphysema (RR 1.37, P=0.427) or pneumonia (RR 0.53, P=0.549). No mortality was observed in either group during the observation period (in-hospital or 30-day mortality). Conclusions: Omitting chest drains in selected patients after VATS seems effective leading to enhanced recovery with shorter length of postoperative stay and less pain but with a higher risk of drain insertion or thoracocentesis. However, a major part of the evidence comes from observational studies with high RoB.Further RCTs are needed to improve the current evidence.

show abstract

It is safe and feasible to omit the chest tube postoperatively for selected patients receiving thoracoscopic pulmonary resection: a meta-analysis

Abstract: This meta-analysis conforms that it is feasible and safe to omit chest tube after thoracoscopic pulmonary resection for patients carefully selected. Randomized controlled trails (RCTs) are urgently needed to verify this conclusion.

Cited by 12 publications

References 27 publications

Single Chest Drain Practice Reduces Discharge Opioid Prescriptions in Thoracic Surgery

Single Chest Drain Practice Reduces Discharge Opioid Prescriptions in Thoracic Surgery

Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care

Efficacy and safety of omitting chest drains after video-assisted thoracoscopic surgery: a systematic review and meta-analysis

Contact Info

Product

Resources

About