Abstract
Purpose
Air leaks are common after pulmonary surgery. Prolonged air leaks (PALs) may persist through discharge and often are managed with one-way valve devices (OWD). We sought to determine the course and complications of patients discharged with OWDs, risk factors for complications, and to evaluate the utility of clamp trials before chest tube (CT) removal.
Methods
Single-institution, retrospective review of patients discharged with a OWD after pulmonary surgery between 2008 and 2022. Charts were examined for the presence of complications and CT duration. Differences in CT duration were compared by using the Wilcoxon rank-sum test.
Result
Sixty-four of 1917 (3.3%) pulmonary surgeries resulted in OWD use. Twelve of 64 (19%) patients discharged with a OWD suffered a complication. Nine of 64 (14%) had a CT-related readmission, and seven of 64 (11%) required PAL intervention. Patients sustaining a complication demonstrated longer CT durations before complication compared with duration in patients without complications, with median days of 13 [IQR 6–21] vs. 7 [IQR 6–12], p = 0.04). Five (7.8%) OWD patients developed an empyema; only one (20%) occurred before a CT duration of 14 days. Sixteen of 64 (25%) patients underwent a clamp trial before CT removal. One of ten (10%) failed even with no air leak present, whereas one of six (17%) failed with a present/questionable air leak.
Conclusions
One-way valve device use has a substantial complication rate, and chest tube duration is a risk factor. In-hospital interventions might benefit patients with larger leaks that likely require prolonged OWD use. Because clamp trials occasionally fail, we contend that a clamp trial is the safest course before CT removal.
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Data Availability
The data underlying this article cannot be shared publicly to protect the privacy of participants. The data will be shared upon reasonable request to the corresponding author.
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Randle: Formal Analysis, Investigation, Data Curation, Writing—Original Draft, Project Administration Bhandari: Formal Analysis He: Formal Analysis, Writing—Review and Editing Berry: Resources, Writing—Review & Editing Backhus: Resources, Writing—Review & Editing Lui: Resources, Writing—Review & Editing Liou: Resources, Writing—Review & Editing Shrager: Conceptualization, Methodology, Data Curation, Writing—Review & Editing, Supervision
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Dr. Joseph Shrager–Becton Dickinson, Advisor
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Randle, R.J., Bhandari, P., He, H. et al. Complications of Outpatient Chest Tube Management for Prolonged Air Leaks After Pulmonary Surgery. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15219-7
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DOI: https://doi.org/10.1245/s10434-024-15219-7