Predictors of Prolonged Chest Tube Duration after Lobectomy: Findings from the Society of Thoracic Surgeons Thoracic Surgery Database
Nathaniel Evans1, Henning Gaissert2, Scott Cowan1, Derek Cyr3, Sung Hee Kim3, William Burfeind4, 1Thomas Jefferson University, Philadelphia, PA, 2Massachussetts General Hospital, Boston, MA, 3Duke Clinical Research Institute, Durham, NC,4St. Lukes University Health Network, Bethlehem, PA
OBJECTIVE: Using data from the Society of Thoracic Surgeons General Thoracic Surgery database, we investigated lobectomy for lung cancer to identify factors associated with prolonged chest tube duration.
METHODS: Patient characteristics of lobectomy cases from 2002 through 2011 with chest tube drainage up to 5 days were compared to those with longer drainage. Independent predictors of prolonged chest tube duration were identified by logistic regression.
RESULTS: Among 33,619 lobectomies for cancer, chest tube data were available in 29,651(88%). Median chest tube duration was 3 days (Figure 1): 4 days after thoracotomy and 3 after thoracoscopy. Of 8054(27%) prolonged chest tube cases, air leak or pneumothorax was present in only 3224(40%). Factors predictive of prolonged chest tube duration were increased age, BMI, male gender, low % predicted FEV1, right-sided operation, active smoking, re-operation and thoracotomy (p <.01 each). Prolonged air leak or pneumothorax were more likely in patients with recent steroid use(OR 1.39) and less likely in diabetics(OR 0.84). Prolonged drainage in the absence of air leak or pneumothorax was associated with chest wall resection(OR 1.72) or congestive heart failure(OR 1.34).
CONCLUSIONS: Prolonged pleural drainage is common after lobectomy for lung cancer, but air leaks account for less than half. Attention to air leak prevention in patients on oral steroids may shorten pleural drainage. Heart failure, a risk factor for prolonged pleural drainage, does not alone explain high rates of tube duration without air leak or pneumothorax. Further investigation and additional database variables may be warranted to address prolonged pleural drainage without air leak.