A prospective randomized, controlled trial deems a drainage of 300 ml/day safe before removal of the last chest drain after video-assisted thoracoscopic surgery lobectomy.

OBJECTIVES

To study the feasible and safe volume threshold for chest tube removal following video-assisted thoracoscopic surgical lobectomy.

METHODS

One hundred and sixty-eight consecutive patients (18 were excluded) who underwent video-assisted thoracoscopic surgery lobectomy or bilobectomy with two incisions between August 2012 and February 2014 were included. Eligible patients were randomized into three groups: Group A (chest tube was removed at a drainage volume of 150 ml/day or less. n = 49); Group B (chest tube was removed when the drainage volume was less than 300 ml/day. n = 50); Group C (chest tube was removed when the drainage volume was less than 450 ml/day. n = 51). The postoperative care of all patients was consistent. The time of extracting the drainage tube, postoperative hospital stay, postoperative visual analogue scale grades, dosage of analgesic, and the incidence of complications and thoracocentesis were measured.

RESULTS

Group B and C had a much shorter drainage time and postoperative hospital stay than Group A (P < 0.05). Compared with Group B, Group C had a notably shorter drainage time (P = 0.036). The postoperative hospital stay was not statistically different between Group B and Group C (P > 0.05). The mean dosage of pethidine hydrochloride was 248.9 ± 33.3 mg in Group B and 226.1 ± 32.7 mg in Group C (P > 0.05). The dosage of pethidine hydrochloride of Group A was significantly higher than that of Group B and C (P < 0.05). The total visual analogue scale (VAS) score during the five days showed no statistical differences compared with Group B and Group C (P > 0.05), Group A had a significantly higher total VAS score than Group B and C (P < 0.05). The number of patients who needed thoracentesis in Group C was more than those in Group B and A (P < 0.05). There were no statistically significant differences in the number of patients who needed reinsertion of chest drains among the three groups (P > 0.05).

CONCLUSIONS

A 300-ml/day volume threshold for chest tube removal after video-assisted thoracoscopic surgery lobectomy is feasible and safe, demonstating more advantages than the 150-ml/day volume threshold. However, a 450-ml/day volume threshold for chest tube removal may increase the risk of thoracentesis compared with the 300- and the 150-ml/day volume threshold.