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Outpatient chest tube management

R B Ponn1, H J Silverman, J A Federico

  • 1Section of Cardiothoracic Surgery, Hospital of St. Raphael, New Haven, Connecticut, USA.

The Annals of Thoracic Surgery
|December 5, 1997
PubMed
Summary

Outpatient management of chest tubes for pleural air evacuation is safe and effective, significantly reducing hospital stays and costs. This approach benefits patients with pneumothorax and those experiencing air leaks post-surgery.

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Area of Science:

  • Thoracic Surgery
  • Pulmonary Medicine
  • Ambulatory Care

Background:

  • Traditionally, patients with indwelling chest tubes for pleural air evacuation require hospitalization.
  • Growing emphasis on cost-effective care and early discharge protocols prompted a review of outpatient chest tube management.

Purpose of the Study:

  • To evaluate the safety and efficacy of outpatient management for patients with indwelling chest tubes and Heimlich valves.
  • To assess the feasibility of ambulatory tube management across various thoracic surgical conditions.

Main Methods:

  • Retrospective review of 240 patients discharged with chest tubes and Heimlich valves over 7 years.
  • Patients were categorized into pneumothorax, prolonged postresection air leak, and outpatient thoracoscopic pulmonary wedge excision groups.
  • Failure was defined as hospital admission due to tube-related complications.

Main Results:

  • Overall failure rate was 4.2% (10 of 240 cases), with low rates for specific conditions (pneumothorax 4.5%, postresection air leak 2%, thoracoscopy 5.3%).
  • No deaths or life-threatening complications were reported.
  • Significant cost savings were achieved, equivalent to at least 1,263 inpatient hospital days.

Conclusions:

  • Chest tube presence does not necessitate hospitalization in all cases, particularly for primary spontaneous pneumothorax.
  • Ambulatory management can shorten postoperative stays for prolonged air leaks and enable outpatient thoracoscopy.
  • Outpatient chest tube management is a safe, cost-effective alternative for selected thoracic surgical patients.

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