A refined approach to chest tube removal: Impact of preoperative pleural fluid culture and nutritional status in non-fistulous empyema surgery

Background

The acute pleural empyema guidelines recommend thoracoscopic-assisted surgery. However, there is no clear guideline for chest tube removal after surgery. This study aimed to evaluate the duration from surgery to chest tube removal, identify associated factors.

Methods

A retrospective cohort study was conducted in 95 patients having non-fistulous empyema due to pulmonary infection caused by common bacteria who underwent surgery at our hospital from January 2011 to March 2023. Postoperative lavage was conducted until two consecutive pleural fluid cultures were negative. The chest tube was clamped and removed if there was no exacerbation of fever or inflammatory findings for 2 days.

Results

Seventy-eight patients (82.1%) were men with a mean age of 72 years. The median duration from surgery to chest tube removal was 14 (interquartile range: 8–22) days. In the multivariable analysis, the independent factors associated with the duration from surgery to chest tube removal were lower prognostic nutritional index (hazard ratio [HR], 1.753; 95% confidence interval [CI], 1.101–2.792; P = 0.018) and positive preoperative pleural fluid culture (HR, 1.867; 95% CI, 1.069–3.261; P = 0.028). Ninety-two (96.8%) patients did not require additional treatment or rehospitalization.

Conclusions

Positive preoperative pleural fluid culture and nutritional status were significant independent factors associated with the duration from surgery to chest tube removal. Almost all patients did not require chest tube reinsertion in our approach. These findings using our approach may guide optimal management of chest tube removal in non-fistulous empyema.