Early Postoperative Day 0 Chest Tube Removal After Thoracoscopic Minor Surgeries

Not Applicable

Recruiting

• Conditions: Lung Pathologies of Unclear Etiology
• Interventions: Procedure: Early postoperative day 0 (POD 0) chest tube removal.; Procedure: Chest tube removal according to traditional standard protocol not earlier than on postoperative day 1 (POD 1).

• Registration Number: NCT04670523
• Lead Sponsor: Insel Gruppe AG, University Hospital Bern

Brief Summary

The safe conditions for early chest tube removal have been progressively questioned and redefined around reliable digital air flow criteria and extension of liquid threshold accepted. Nevertheless, in current practice, the chest tube remains in restricting early mobilization and optimal compliance with ERAS programme, during the first crucial 24 h after surgery. Thus, to go further, the investigators decide to assess in this study the safety of POD 0 chest tube removal after minor thoracic operations in patients in health condition tolerating operation and anesthesia.

Detailed Description

Chest tube management is a key element of postoperative care after thoracic surgeries for different indications. During the last decade, minimally invasive surgery and enhanced recovery after surgery (ERAS) programmes have radically changed the equation of recovery, contributing to reduce postoperative morbidity and enhance quality of life, but the chest tube remains its Achilles heel, still providing postoperative pain and impairing pulmonary function. In this view, early chest tube removal has been widely promoted not only for its economic benefits on length of stay but also for improving quality of life and potentially reducing postoperative complications. In parallel, the change from traditional chest drainage devices to electronic devices has also enabled a more accurate air leak measurement with reduction of interobserver variability, decreased chest drainage duration and shortened LOS. The safe conditions for early chest tube removal have been progressively questioned and redefined around reliable digital air flow criteria and extension of liquid threshold accepted. Nevertheless, in current practice, the chest tube remains in restricting early mobilization and optimal compliance with ERAS programme, during the first crucial 24 h after surgery. Thus, to go further, the investigators decide to assess in this study the safety of POD 0 chest tube removal after minor thoracic operations in patients in health condition tolerating operation and anesthesia.

Study Timeline

• Study First Submitted: 2020-11-27
• Study First Submitted QC: 2020-12-10
• Study First Posted: 2020-12-17
• Study Start: 2023-01-06
• Status Verified: 2025-03
• Last Update Submitted: 2025-03-25
• Last Update Posted: 2025-03-26
• Primary Completion: 2027-12-31
• Study Completion: 2027-12-31

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 304

Inclusion Criteria

1. Thoracoscopic extra-anatomical lung resection (surgical lung biopsy)
2. Thoracoscopic pleural biopsy
3. Signed consent
4. Age of majority

Exclusion Criteria

1. Anatomical resection
2. Empyema
3. Pleural effusion
4. Pleurodesis
5. Vulnerable persons (Pregnant women, Children and adolescents)

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Test group	Early postoperative day 0 (POD 0) chest tube removal.	Test group: The patients of the study group are getting their chest tube removed according to the investigators' current airleak protocol (Flow \<20 mL/ min on digital suction device) but already in the operating room immediately following wound closure (Postoperative day 0 (POD0)). If airleak is persisting than chest tube removal will be performed according to the traditional protocol not earlier than on postoperative day 1 (POD 1).
Control group	Chest tube removal according to traditional standard protocol not earlier than on postoperative day 1 (POD 1).	In the control group, the chest tube gets removed according to the investigators' traditional standard protocol not earlier than on postoperative day 1 (POD1).

Primary Outcome Measures

Name	Time	Method
2. Pleural effusion requiring thoracocentesis	Pleural effusion 2 hours after chest tube removal between POD 0 and 30	Number of patients with pleural effusion requiring thoracocentesis after removal of first chest tube
3. Prolonged air leak > 5 days	Chest tube removal between POD 6 and 30	Number of patients with persisting air leak longer than 5 days
1. Pneumothorax requiring chest tube reinsertion	Pneumothorax 2 hours after chest tube removal between postoperative day 0 and 30 (POD 0 - 30)	Number of patients with pneumothorax requiring chest tube reinsertion after removal of initial chest tube
4. Re-admission or reoperation due to pleural complication	Up to 1 month after first operation	Number of patients re-admitted to a hospital after first hospitalization

Secondary Outcome Measures

Name	Time	Method
2. Re-operation	Up to 1 month after initial operation	Number of patients requiring a re-operation after initial operation
3. Length of drainage (days)	Up to 1 month after initial operation	Average of time with chest tube in site
4. Length of stay (days)	Up to 1 month after initial operation	Average of time in hospital
1. Cardiopulmonary complications (Pneumonia, Atrial fibrillation, ARDS)	Up to 1 month after initial operation	Number of patients with cardiopulmonary complications (Pneumonia, Atrial fibrillation, ARDS) after operation

Trial Locations

Locations (1)

University Hospital of Bern, Inselspital; 🇨🇭 Bern, Switzerland