Active clearance of chest tubes is associated with reduced postoperative complications and costs after cardiac surgery:
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(2019) 14:192
RESEARCH ARTICLE
Open Access
Active clearance of chest tubes is associated with reduced postoperative complications and costs after cardiac surgery: a propensity matched analysis Yvon Baribeau1*, Benjamin Westbrook1, Yanick Baribeau2, Simon Maltais3, Edward M. Boyle4 and Louis P. Perrault5
Abstract Background: Chest tubes are routinely used to evacuate shed mediastinal blood in the critical care setting in the early hours after heart surgery. Inadequate evacuation of shed mediastinal blood due to chest tube clogging may result in retained blood around the heart and lungs after cardiac surgery. The objective of this study was to compare if active chest tube clearance reduces the incidence of retained blood complications and associated hospital resource utilization after cardiac surgery. Methods: Propensity matched analysis of 697 consecutive patients who underwent cardiac surgery at a single center. 302 patients served as a baseline control (Phase 0), 58 patients in a training and compliance verification period (Phase 1) and 337 were treated prospectively using active tube clearance (Phase 2). The need to drain retained blood, pleural effusions, postoperative atrial fibrillation, ICU resource utilization and hospital costs were assessed. Results: Propensity matched patients in Phase 2 had a reduced need for drainage procedures for pleural effusions (22% vs. 8.1%, p < 0.001) and reduced postoperative atrial fibrillation (37 to 25%, P = 0.011). This corresponded with fewer hours in the ICU (43.5 [24–79] vs 30 [24–49], p = < 0.001), reduced median postoperative length of stay (6 [4–8] vs 5 [4–6.25], p < 0.001) median costs reduced by $1831.45 (− 3580.52; 82.38, p = 0.04) and the mean costs reduced by an average of $2696 (− 6027.59;880.93, 0.116). Conclusions: This evidence supports the concept that efforts to actively maintain chest tube patency in early recovery is useful in improving outcomes and reducing resource utilization and costs after cardiac surgery. Trial registration: Clinicaltrial.gov, NCT02145858, Registered: May 23, 2014. Keywords: Chest tube, Cardiac surgery, Critical care, Postoperative atrial fibrillation, Pleural effusion, Costs
Background In the early hours after heart surgery shed mediastinal blood accumulates until the postoperative bleeding stops. Shed mediastinal blood is evacuated by chest tubes positioned around the heart and lungs connected to external blood collection canisters set to suction. Chest tube clogging, however, can lead to un-evacuated shed mediastinal retained around the heart and lungs [1, * Correspondence: [email protected] 1 Department of Cardiac Surgery, New England Heart and Vascular Institute, Catholic Medical Center, 100 McGregor St, Manchester, NH 03102, USA Full list of author information is available at the end of the article
2]. This can contribute to the development of tamponade, hemothorax, or bloody pericardial and pleural effusions. Patients with retained blood have more complications including postoperative atrial fibrillation (POAF) an
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