Challenging tradition: Pediatric thoracotomy can be performed safely without a chest tube: A retrospective study

Chest tubes have traditionally been inserted after thoracotomy to evacuate air and fluid, thereby preventing inadequate lung expansion or tension pneumothorax. However, this practice has recently been questioned. This study was aimed at assessing the safety of omitting chest tube insertion in pediatric patients undergoing thoracotomy.

We conducted a retrospective study among all pediatric patients younger than 19 years who underwent thoracotomy between January 2016 and October 2018 at our center. Data including patient demographics and surgical outcomes were collected and compared between all patients with vs without intraoperative chest tube insertion.

Among 66 identified patients, 38 (57.6 %) had a chest tube inserted (CT group), and 28 (42.4 %) had no chest tube inserted (NCT group) intraoperatively. The median patient age was 13 years (range 1-19 years). A total of 59 patients (89.4 %) underwent lung wedge resection, 4 (6.1 %) underwent rib excision, and 3 (4.5 %) underwent thoracotomy for mediastinal mass excision. Among the patients who underwent lung wedge resection, fewer than three lesions were resected from the lung in 24 patients (96.0 %) in the NCT group and 25 patients (73.5 %) in the CT group, representing a statistically significant difference (P = 0.034).The median hospital stay in the CT group (5 (range 2, 15) days) was significantly longer than that in the NCT group (2.50 (range 1, 8) days) (P ≥ 0.0001). Follow-up imaging indicated full lung expansion in 34 patients (89.5 %) in the CT group and 23 patients (82.1 %) in the NCT group (no significant difference; p = 0.47). No mortalities or readmissions were reported.

In pediatric thoracotomy, especially with fewer than three lung wedge resections, chest tube insertion can be safely omitted. This approach does not increase the postoperative chest tube insertion rate and is associated with shorter hospital stays.