How soon should we remove a chest drain following anatomic lung resection?

Chest drain duration has a key influence on recovery post-thoracic surgery. There is no universally accepted protocol determining the timing of chest drain removal. We aim to review and discuss the factors that determine how soon chest drains can be removed following anatomic lung resection.

Fluid output and air leak are the main determinants of chest drain removal. We reviewed the literature to determine which cut offs have been proposed and the use of protocol for decision-making in chest drain removal.

Use of air leak alone as the determinant for chest drain removal optimizes chest drain management, and studies that have utilized this protocol can achieve drain removal on the 1st postoperative day in most cases. Moving forward, surgery without routine chest drains can help move towards day case thoracic surgery, even for anatomic lung resection.

Utilizing digital drainage with a strict air leak protocol helps to minimize drain duration post lung resection. The future landscape of chest drain management should focus on the usage of chest drains on an as required basis for air leak, even for anatomic lung resection.