Objective

For patients undergoing thoracic surgery at our institution, we aimed to evaluate surgeon decision versus protocol management of chest drain in terms of length of hospital stay and drain related complications.

Methods

In 2015, we instituted protocolised management of chest drain using no fluid criteria and air leak of less than 20ml/min duration for 6 hours. Patients were excluded for lung volume reduction surgery, pneumonectomy, if no chest drain was inserted, if only underwater seal was used and withdrawn for suspected bleeding or chylothorax.

Results

February to October 2014 and 2015, a total of 1107 patients underwent surgery with 589 excluded and 85 withdrawn. Patients from a surgeon using the same protocol were also excluded leaving 301 patients for analysis. There was an observed reduction in the incidence of post-drain removal pneumothorax (13.8% to 9.0%; P=0.008) with no difference in post-drain pleural effusion (13.8% to 10.1%; P=0.448).

Conclusion

Using protocolised chest drain management allows objective decision making on drain removal shortening the length of drain, length of stay without any increase in complications.