The impact of a chest drainage system on retained blood-associated complications after cardiac surgery

Ineffective drainage can lead to retained blood syndrome (RBS), bleeding-associated complications and more postoperative atrial fibrillation (AF). The present study compares outcomes of conventional, active tube clearance (ATC) and portable digital drainage systems after myocardial revascularization.

Data from 1222 patients undergoing elective myocardial revascularization with or without a concomitant aortic or mitral valve procedure were considered; data from 1065 patients were retrieved and data from 1049 patients were analysed retrospectively. Patients who received conventional treatment were compared to those treated with ATC and portable digital drainage. Propensity weighting, including comorbidities, medication and perioperative characteristics, was applied for outcome assessment.

In propensity-adjusted patients, 14.6% of conventional patients had interventions for RBS, with 4.1% underdoing early re-exploration for bleeding. In the ATC group, 6.9% required interventions for RBS [odds ratio (OR) 0.43, P < 0.001] with a 3.7% re-exploration rate. Patients in the portable digital drainage group had RBS in 5.1% (OR 0.31, P < 0.001) with a 1.2% rate of re-exploration (OR 0.29, P < 0.001). Postoperative AF dropped by 37% from 29.8% in the conventional to 18.7% in the portable digital drainage cohort (OR 0.31, P < 0.001). In-hospital mortality was similar with 1.6% (6 of 369) in the conventional versus 1.1% (2 of 188) in the ATC versus 0.8% (4 of 492) in the portable digital drainage cohort (P = 0.358).

Active tube clearance and portable digital drainage cohorts had fewer RBS interventions. In addition, portable digital drainage was associated with reduced early re-exploration for bleeding and lower postoperative AF. Immediately effective chest drainage is crucial to minimize RBS complications postoperatively.