Chest drains after open paediatric lung resections: not always required
Georges Kamil Tinawi1, Prabal Mishra2
1Department of Paediatric Surgery, Wellington Children's Hospital, 23 Mein Street, Newtown, Wellington, 6021, New Zealand. Gtinawi44@gmail.com.
Insights
Selective chest drain omission after pediatric open lung resection is safe and reduces hospital stay. This approach avoids complications and reintervention, offering a better patient experience.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Chest drains cause pain and anxiety in pediatric patients.
- Evidence supports omitting drains after thoracoscopic lung resection in children.
- Safety of omitting drains after open lung resection in children is unevaluated.
Purpose of the Study:
- Evaluate the safety of selective chest drain placement in children undergoing open lung resection.
- Describe institutional experience with selective chest drain omission.
- Report complication profile of selective chest drain placement.
Main Methods:
- Retrospective review of open lung resections in children (<16 years) from June 2009 to June 2022.
- Analysis of clinical, radiological, and operative outcomes.
- Comparison between children with and without intraoperative chest drains.
Main Results:
- 35 children underwent open lung resection; 8 (23%) had no drain, 29 (77%) had drains.
- Children without drains had significantly shorter hospital stays (2.5 vs. 5.0 days).
- No significant differences in complication rates, reintervention, residual pneumothorax, or effusion between groups.
Conclusions:
- Chest drains are not always necessary after pediatric open lung resection.
- Selective omission of chest drains is safe, with no increased complications or reinterventions.
- Omitting chest drains is associated with shorter hospital stays.
Introduction:
Chest drains are often a great source of pain and anxiety in paediatric patients. While there is growing evidence to support the selective omission of chest drains after thorascopic lung resection in children, the safety of this practice following open lung resection has yet to be evaluated. Chest drains are not routinely placed at our institution. We therefore aimed to describe our experience of selective chest drain placement in children undergoing open lung resection, and report the safety and complication profile of this practice.
Methods:
Retrospective review of all open lung resections performed at Wellington Regional Hospital, in children < 16 years of age, from June 2009 to June 2022. Clinical, radiological and operative outcomes were identified and analyzed. The cohort was divided into two groups - those that had a chest drain placed intraoperatively, and those that did not.
Results:
35 children underwent open lung resection over the study period. The mean operative age was 8.0 ± 5.4 months, with the most common resection being a lobectomy (80%). Eight children (23%) did not have a chest drain placed, whereas the remaining 29 children (77%) had at least one drain placed intraoperatively, with a median drainage time of 3.0 days. Length of stay was significantly shorter in children who did not have a chest drain placed intraoperatively, compared to those that did (2.5 vs. 5.0 days, p = 0.019). There were no significant differences observed in complication or reintervention rates between the two groups. Similarly, there were no significant differences in the incidence of a residual pneumothorax or effusion on the pre-discharge CXR between the groups.
Conclusions:
Chest drains may not always be required following open paediatric lung resection. The selective omission of a chest drain following open lung resection, does not appear to result in a significantly higher rate of complications or reintervention, and is associated with significantly shorter hospital length of stay.
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