David Sahai BSc , Richard C. Chaulk MD , Richard Malthaner MD , Mehdi Qiabi MD , Dalilah Fortin MD , Richard Inculet MD , Rahul Nayak MD
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Abstract
Background
The current practice for patients undergoing minimally invasive pulmonary wedge resection (MIS-PWR) is to remain in hospital with a chest tube (CT) in situ for at least 24 hours. There exists emerging evidence that patients typically do not encounter significant complications during this period. However, this has not been studied prospectively.
Research Question
Is it feasible and safe for patients to undergo early CT removal and same day discharge (SDD) after elective MIS-PWR?
Study Design and Methods
We conducted a nonrandomized prospective clinical trial in 2 phases to assess early CT removal and SDD after elective MIS-PWR. Phase 1 focused on the safety of early CT removal with patients undergoing removal at 4 hours postoperatively. Phase 2 evaluated both early CT removal and SDD. The primary outcomes were rate of successful early CT removal and the rate of successful SDD.
Results
In phase 1, a total of 51 patients were enrolled (intervention group: n = 31, control group: n = 20). In the intervention group, 22 (71%) had early removal of CT. Patients who underwent early CT removal in this phase had a significantly shorter median length of hospital stay in days (2.0 in control group vs 1.0 in intervention group; P = .0185) without significant differences in postoperative day 1 and 30 complications or return to the hospital. In phase 2, a total of 43 patients were enrolled (intervention group: n = 23, control group: n = 20). In the intervention group, 17 (74%) had early CT removal and 14 (61%) successfully underwent SDD. There were no significant differences noted in postoperative day 1 and 30 complications or early return to hospital. No patients required pleural reintervention after early CT removal.
Interpretation
Our results indicate that select patients undergoing MIS-PWR can safely undergo early CT removal and can be safely discharged on the day of surgery.
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