Prospective Study to Evaluate the Role of Protocol-Based Management of Chest Tubes in Patients Undergoing Elective Thoracic Surgery

Intercostal chest tube (ICD) management has been mostly determined by personal experience of surgeons and prevailing local practices rather than a scientifically validated protocol. This study was done to evaluate the impact of protocol-based management of chest tubes in patients undergoing elective thoracic surgeries. This was a prospective observational study conducted from June 2016 to March 2018 at a tertiary care hospital to study the impact of algorithmic management of chest tubes in patients undergoing non-pneumonectomy elective thoracic surgery. A preformed algorithm was followed in all the patients. Chest tube was removed if all the criteria for chest tube removal were met, i.e., stable patient, no air leak, drainage < 250 ml, and no (or small non-expanding) pneumothorax. Out of 122 patients recruited in study, 45.08% patients underwent operations for inflammatory lung and pleural conditions. ICD protocol could be followed in 101 patients, and 84 patients were discharged according to the protocol. Chest tube dwelling time and post-operative hospital stay were significantly less in patient in whom protocol was followed vis-a-vis those in whom it could not be followed. Reinsertions were significantly higher in patients in whom protocol could not be followed. No difference in readmissions and mortality was noted. Comparison with data before starting of the study revealed an early ICD removal, and discharge was possible in prospective patients. Protocol-based management in patients undergoing elective thoracic surgeries decreases the chest tube dwelling time and post-operative hospital stay without increasing morbidity and mortality.