Early Mediastinal Chest Tube Removal following Cardiac Surgery is Rarely Associated with Pericardial Effusion...

There are no widely accepted guidelines for mediastinal chest tube removal following cardiopulmonary bypass (CPB) surgery and management is highly variable. The aim of this retrospective study was to review our institutional routine of mediastinal chest tube removal on postoperative day (POD) one. We retrospectively reviewed patients undergoing CPB surgery from January 1, 2023 to December 31, 2023, with mediastinal chest tube removal on POD 1. Variables examined included age, operation, chest tube output, postoperative complications, hospital length of stay, discharge tests, and readmission within 30 days. Two hundred thirteen patients underwent CPB surgery of which 158 (74%) had their mediastinal chest tubes removed on POD 1 (study group). Patient age was median 1.6 years (range 2 days to 39 years). Top 3 operations included 27 atrial septal defect repair, 26 ventricular septal defect repair, and 24 left ventricular outflow tract operations. Postoperative duration of mediastinal chest tube was median 22 h (range 11-36). Mediastinal chest tube output from midnight to removal was median 0.29 mL/kg/hr (range 0-1.23). Four major postoperative complications: 2 unplanned cardiac reoperation, 1 unplanned cardiac catheterization, and 1 permanent pacemaker placement for heart block. Fourteen patients (9%) had small pericardial effusions on discharge echocardiogram. Average postoperative hospital length of stay was 7 ± 11 days; median 4 days (range 2-78). Ten patients (6%) readmitted within 30 days of discharge. Four patients (2.5%) with pericardial effusions; three (2%) required pericardial drain. Thus, early mediastinal chest tube removal following CPB surgery was rarely associated with pericardial effusion requiring intervention.