BOB Ped Surg 2023 - Jamie Schnuck, PAPS - Presentation

Hello. My name is Jamie Schnuck and I'm currently a general surgery resident at the University of Washington. Thank you for listening to my presentation entitled Chest Tube Management Following Lung Resection, a retrospective analysis. Plural drainage is nearly universally practiced in pediatric patients following lung resection. And it's often associated with increased pain, anxiety, subjecting the patients to additional chest X-rays and may even prolong hospitalizations. We've seen in the adult literature that the elimination of routine chest tubes is a part of enhanced recovery after surgery pathways or ERAS in select patients. We sought to clarify the utility of routine chest tube placement during pulmonary wedge resection or lobectomy in pediatric patients and ultimately guide development of a protocolized approach to eliminate routine plural drainage and select patients undergoing lung resection altogether. We performed a retrospective chart review of all patients less than 21 years of age who underwent either pulmonary lobectomy or wedge resection at one academic Children's Hospital. Patients who underwent wedge resection for a spontaneous pneumothorax were excluded. 130 procedures met inclusion criteria and were subsequently divided into three groups. Group one included 59 patients who underwent lobectomy. Group two had 19 patients who underwent a diagnostic wedge resection for an unknown underlying lung disease. And group three included 52 patients who had an excisional wedge resection for oncologic disease with concern for metastasis. You can see our variables that we included here. In group one, 59 patients who underwent lobectomy, nearly 75% of these patients did not have an air leak noted post-operatively and their median chest tube duration was two days. There were 15 patients who did have a documented air leak and their median chest tube duration was two days as well. Of the 19 patients who underwent a diagnostic wedge resection, nearly 90% of patients did not have an air leak noted post-operatively and median chest tube duration was one day. Of the remaining patients with a documented air leak, it only lasted for one day and their chest tubes were removed on post-op day two. In group three, patients who had an excisional wedge resection, 80% of patients did not have an air leak noted post-operatively and median chest tube duration was one day. Of the remaining 10 patients who did have an air leak, median chest tube duration was two days. Overall, 43% of patients had their chest tube removed on post-op day one. 22% had their chest tube removed on post-op day two, and a quarter of these patients had their chest tube left in place for a documented air leak. The remaining 35% of patients had their chest tube removed on post-op day three or later. So in conclusion, chest tube duration following lung resection in children is typically brief with removal within one to two days post-operatively. And we further postulate that avoidance of chest tube placement may reduce post-operative pain and hospital length of stay. Our future directions include developing an ERAS protocol following lung resection in pediatric patients with the standardization of a leak test, which would include placement of a temporary chest tube to evaluate the presence or absence of an air leak at the end of the case before the patient even leaves the OR. Hoping to eliminate chest tube drainage in a select group of patients altogether. Thank you for your time.