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Routine placement of an intercostal chest drain during video-assisted thoracoscopic surgical lung biopsy unnecessarily prolongs in-hospital length of stay in selected patients

^a Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, Wales, UK
^b Heart & Lung Centre, New Cross Hospital, Wolverhampton, UK

Received 2 November 2008; received in revised form 20 April 2009; accepted 22 April 2009.

^_* Corresponding author. Address: Block C5, Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, Wales, UK. Tel.: +44 (0)2920 747747; fax: +44 (0)2920 745439. (Email: lucysatherley{at}hotmail.com).

Objective: Video-assisted thoracoscopic surgical (VATS) lung biopsy is frequently used in the diagnosis of parenchymal lung disease. However, there is still debate over the need for routine use of an intercostal chest drain after this procedure. This study aimed to evaluate the necessity of positioning an intercostal chest drain as an integral part of VATS lung biopsy. Methods: Data from VATS lung biopsies performed over a 5-year period were retrospectively analysed. Patients in whom there was evidence of air leak intra-operatively following lung biopsy were excluded. Patients in whom no air leak was detected on testing were included in this study. A chest drain was inserted solely according to the surgeons’ practice. Results: This study included 175 patients. Of these, 82 patients had an intercostal chest drain positioned during the VATS procedure and 93 did not. There were no significant differences between the two groups in terms of mean (standard deviation (SD)), age (54.4 (14.9) vs 55.8 (13.5) years, p = 0.58), gender (63% vs 59% males, p = 0.56) or side of procedure (45% vs 56% right side, p = 0.22). One patient in the ‘no drain’ group developed a clinically significant pneumothorax 24 h after surgery and required a drain to be inserted. There was also no significant difference between the two groups in the incidence of radiologically detected pneumothorax immediately post-procedure (23% vs 20%, p = 0.66) or on postoperative day 1 (26% vs 20%, p = 0.63). There was no significant difference in the incidence of pneumothorax on follow-up (at 4–6 weeks) chest radiograph (10% vs 7%, p = 0.61). In all cases, the pneumothoraces were small and not clinically significant. However, there was a significant difference in the median (inter-quartile range (IQR)) length of stay between the two groups (3 (2,4) vs 2 (1,3) days, respectively, p < 0.001). Conclusions: The routine use of an intercostal chest drain after VATS lung biopsy unnecessarily increases the length of hospital stay without reduction in the incidence of pneumothorax.

Key Words: VATS lung biopsy • Chest drain