Early chest tube removal after surgery for primary spontaneous pneumothorax

Objective The purpose of this study was to analyze the safety and validity of early chest tube removal after bullectomy for primary spontaneous pneumothorax (PSP). Methods Between January 2005 and July 2018, 123 cases of thoracoscopic surgery for PSP were reviewed. The principle procedure was bullectomy accompanied by mechanical and chemical pleurodesis. Approximately 4 h after surgery, we confirmed patients' sufficient recovery from anesthesia and investigated the presence of air leak in a sitting position. Chest tubes were removed on the same day as the surgery if there was no air leak or bloody drainage observed. Postoperative complications and factors that prevented early chest tube removal were analyzed by comparing the early removal group and the remaining tube group. Results Chest tubes could be removed on the day of the surgery in 105 cases (85.4%). There were 7 cases (5.7%) in which chest tubes could be removed because air leak was not detected after patients' recovery despite intraoperative detection of minor air leak from the resection stump. No patients required chest tube reinsertion during their hospital stay. The mean length of postoperative hospital stay was 1.1 +/- 0.5 days. In a logistic regression analysis, surgical history of ipsilateral PSP was independently and significantly associated with the prevention of early chest tube removal. Conclusions Chest tube removal on the day of surgery for PSP appears to be safe when air leak examination can be performed after sufficient recovery from anesthesia.