Single chest tube drainage is superior to double chest tube drainage after lobectomy: a meta-analysis
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RESEARCH ARTICLE
Open Access
Single chest tube drainage is superior to double chest tube drainage after lobectomy: a meta-analysis Dong Zhou1, Xu-Feng Deng1, Quan-Xing Liu1, Qian Chen2, Jia-Xin Min1 and Ji-Gang Dai1*
Abstract Background: In this meta-analysis, we conducted a pooled analysis of clinical studies comparing the efficacy of single chest tube versus double chest tube after a lobectomy. Methods: According to the recommendations of the Cochrane Collaboration, we established a rigorous study protocol. We performed a systematic electronic search of the PubMed, Embase, Cochrane Library and Web of Science databases to identify articles to include in our meta-analysis. A literature search was performed using relevant keywords. A meta-analysis was performed using RevMan© software. Results: Five studies, published between 2003 and 2014, including 630 patients (314 patients with a single chest tube and 316 patients with a double chest tube), met the selection criteria. From the available data, the patients using a single tube demonstrated significantly decreased postoperative pain [weighted mean difference [WMD] −0.60; 95 % confidence intervals [CIs] −0.68–− 0.52; P < 0.00001], duration of drainage [WMD −0.70; 95 % CIs −0.90–− 0.49; P < 0.00001] and hospital stay [WMD −0.51; 95 % CIs −0.91–− 0.12; P = 0.01] compared to patients using a double tube after a pulmonary lobectomy. However, there were no significant differences in postoperative complications [OR 0.91; 95 % CIs 0.57–1.44; P = 0.67] and re-drainage rates [OR 0.81; 95 % CIs 0.42–1.58; P = 0.54]. Conclusion: Our results showed that a single-drain method is effective, reducing postoperative pain, hospitalization times and duration of drainage in patients who undergo a lobectomy. Moreover, the single-drain method does not increase the occurrence of postoperative complications and re-drainage rates. Keywords: Chest tube, Lobectomy, Drainage, Pain, Complications
Background Intercostal chest drains are a routine component of the management of the pleural space after intrathoracic surgery. These drains are mainly used to remove liquid or air from the pleural space. The conventional method of pleural drainage after a thoracotomy or a lobectomy is the use of double chest drains placed in the apical and basal positions before closure [1, 2]. Although these drains are effective and widely accepted, they are painful for the patients, particularly during their removal.
* Correspondence: [email protected] 1 Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China Full list of author information is available at the end of the article
In 2003, the ‘best evidence topic’ in The Annals of Thoracic Surgery addressed whether one- or two-tube chest drains in patients undergoing a lobectomy reduced postoperative pain [3]. The first study suggested that single chest drains may be superior to the conventional double chest drains in terms of patient tolerability and cost-effectiveness, as well as applicability to thoracic sur
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