Outpatient chest tube management

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.