Association Between Chest Tube Removal, Risk of Pleural Effusion, and Opioid Usage

Abstract

Purpose – There are no established guidelines regarding optimal timing of chest tube removal after cardiac surgery. This decision is often surgeon-specific, with commonly utilized criteria including drainage volume or time after surgery. We investigated the relationship between drainage volume, timing of chest tube removal, and risk of post-removal pleural effusion.

Methods – Single-center retrospective study of patients who underwent non-emergent cardiac surgery via median sternotomy at our institution. Subjects were grouped by volume of chest tube output in the 24-hours (High [≥200 mL] vs. Low [<200 mL]) and 12-hours (High [≥100 mL] vs Low [<100 mL]) immediately prior to chest tube removal and by day of chest tube removal (Early [≤postoperative day 2] vs Late [>postoperative day 2]). Primary and secondary outcomes analyzed were incidence of pleural effusion requiring intervention following chest tube removal and opioid analgesic usage after chest tube removal, respectively. Bivariate and multivariate analyses were performed.

Results – A total of 351 patients were included. 15 patients developed post-removal pleural effusion. 24 and 12-hour chest tube output immediately preceding chest tube removal were not associated with post-removal pleural effusion formation (p=0.541 and p=0.326, respectively). Postoperative day of chest tube removal was also not associated with pleural effusion formation (p=0.461). Of the patients who developed post-removal pleural effusion, 67% (10/15) were female (p=0.010) and 47% (7/15) had a history of endocarditis (p=0.015). Early chest tube removal (on or before postoperative day 2) was associated with a significant decrease in opioid analgesic usage when compared to Late chest tube removal (113 morphine milligram equivalents vs 151 morphine milligram equivalents, p=0.007) in patients without a history of IV drug use.

Conclusions - Chest tube output volume and removal day are not associated with an increased risk of post-removal pleural effusion. Chest tube removal is associated with a decrease in opioid use in some patients. Early removal of chest tubes following cardiac surgery might provide clinical benefit without associated increased risk of complications.