Progressive Versus Conservative Chest Tube Management Following Surgery for Primary Spontaneous Pneumothorax

"Enhanced recovery after thoracic surgery" is increasingly implemented following surgery for primary spontaneous pneumothorax (PSP). Historically, postoperative chest tubes are left in place for several days to ensure adequate pleurodesis and prevent recurrence. Prompt chest tube removal upon cessation of air leakage may enhance recovery but potentially increases risk of recurrence. We evaluated progressive chest tube management following surgical pleurodesis for PSP.

Retrospective multicentre study of patients undergoing surgical pleurodesis for PSP between 2020 and 2023. Hospitals with implemented progressive chest tube management (removal upon cessation of air leakage <8 hours) were compared against hospitals with conservative management (removal after 1-2 days). Outcome measures, corrected for bias using directed acyclic graphs, were postoperative length of stay (LOS), chest tube duration, complications, and ipsilateral recurrences.

A total of 183 patients from 5 hospitals were included: 99 patients in the progressive and 84 in the conservative group. Follow-up and baseline characteristics were comparable, except for surgical indication, pleurodesis technique, and use of postoperative chest X-ray. Progressive management significantly reduced LOS (Δ1 day), chest tube duration (Δ2 days), and complications (9.1 vs 21.4%). After correction for pleurodesis technique, persistent air leakage, and chest X-ray, LOS was reduced by 1.03 day (P < .001). Recurrences (6.6%) were similar across groups (P = .388).

Progressive chest tube management reduces LOS, chest tube duration, and complications without increasing the risk of recurrence in this retrospective comparative study. A prospective study is necessary to validate these findings before considering widespread implementation.