Factors in the Selection and Management of Chest Tubes After Pulmonary Lobectomy: Results of a National Survey of Thoracic Surgeons.

BACKGROUND: This study determined patterns of chest tube (CT) selection and management after open lobectomy and minimally invasive lobectomy by thoracic surgeons.

METHODS: Surveys were sent electronically to 5,175 thoracic surgeons, and 475 were completed. Responses, blinded so individuals could not be identified, were analyzed and compared according to surgeon characteristics (academic/private practice, years in practice, lobectomy volume, and geographic region). All indicated differences were statistically significant (p < 0.05 by χ(2) tests).

RESULTS: CT selection: Most surgeons prefer rigid tubes, and the size most commonly used was 28F. Most place 2 CTs after open lobectomy and 1 CT after minimally invasive lobectomy. Academic surgeons are more likely than private surgeons to use 1 tube after open lobectomy, but both prefer 1 tube after minimally invasive lobectomy. Younger surgeons and high-volume surgeons are more likely to use 1 CT than senior surgeons and low-volume surgeons after both open lobectomy and minimally invasive lobectomy. CT management: Academic and younger surgeons remove the CT sooner after open lobectomy. Younger and high-volume surgeons remove the CT with greater drainage amounts. All groups remove CTs sooner after minimally invasive lobectomy than after open lobectomy. Approximately half of surgeons get a daily chest roentgenogram. Younger and low-volume surgeons are most likely to discharge patients with Heimlich valves, although overall use was in less than 5% (49 of 475) of respondents. Most surgeons believe clinical experience rather than training or the literature determined their CT strategy.

CONCLUSIONS: This survey determined the difference in CT management among various groups of surgeons. Clinical experience was the most important factor in determining their CT strategy.