Active Chest Tube Clearance After Cardiac Surgery Improves Post-operative Complication Rates Over Standard Chest Tubes
Meghan O. Kelly1, Joshua L. Manghelli2, Daniel I. Carter1, Robert M. MacGregor1, Samuel C. Perez1, Nadia H. Bakir1, Junedh M. Amrute1, Richard B. Schuessler1, Ralph J. Damiano1, Spencer J. Melby1.
1Washington University in St. Louis, St. Louis, MO, USA, 2Indiana University, Indianapolis, IN, USA.
BACKGROUND--Chest tubes (CTs) are inserted after cardiac surgery to clear blood and fluid from the pericardial space during recovery. Prior studies using standard CTs have shown ineffective drainage with standard CTs and post-operative complications related to retained blood. A CT with technology to maintain patency may decrease complications. We evaluated post-operative outcomes for cardiac surgery patients who received active clearance CTs. METHODS--Between February 2018 and March 2019, 600 patients underwent cardiac surgery at a single institution and received active clearance CTs. Data were collected on outcomes. These 600 patients were compared to 2,000 historical control patients. Propensity score matching was conducted on 22 covariates using a 0.1 caliper logistic model with nearest neighbor 1:1 matching. Outcomes for matched pairs were evaluated using the Wilcoxon signed rank test or McNemar's test, as appropriate. Post-operative complications and 30-day mortality were evaluated statistically, and presence of a complication related to retained blood was evaluated as a composite endpoint. RESULTS--Propensity score matching yielded 477 patients in the active clearance CT and standard CT groups. There was a 91% reduction in the composite endpoint of need for retained blood intervention for the active clearance CT group relative to controls [2(<1%) vs 23(5%); P<0.001]. Retained blood intervention included hemothorax, reoperation for hemorrhage, pericardial drainage, placement/replacement of CT, thoracentesis or thoracotomy. The active clearance CT group had lower rates of infection [0(0%) vs 7(1%); P=0.023], need for postoperative blood products [255(53%) vs 291(61%); P=0.026], reoperation for hemorrhage [0(0%) vs 11(2%); P=0.003], readmission for post-operative atrial fibrillation (POAF) or retained blood intervention [39(8%) vs 79(17%); P<0.001], and reintubation [0(0%) vs 7(1%); P=0.023]. There was no difference in POAF, post-surgery length of stay, or 30-day mortality. CONCLUSIONS--Implementing an active clearance technology CT was associated with decreased post-operative complications related to retained blood, decreased need for postoperative blood products, lower rates of reoperation, and lower rates of readmission for associated problems with retained blood. A randomized trial is needed to verify these findings.
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