PURPOSE: Pleural effusions are a common occurrence following heart surgery, occasionally resulting in significant postoperative morbidity. The cause of pleural effusion is multifactorial. Symptomatic pleural effusion is the result of inadequate and incomplete drainage. This study is designed to determine whether the presence of a supplemental drain postoperatively results in a decrease in symptomatic left pleural effusion (SLPE) post-CABG surgery.
METHODS: A total of 168 consecutive CABG / CABG plus valve patients were followed until 30-days postoperatively. Each patient had two mediastinal and one left pleural drains –a silastic (Blake) drain versus traditional thoracostomy tube. Drainage tubes were removed on POD 1 unless drainage was greater than 100cc over the last 8 hours. The pleural silastic drain was placed to bulb suction and left in place for an additional 3-5 days. Patients that became symptomatic from a pleural effusion were treated.
RESULTS: A total of 146 patients were included in the study. Data revealed that 19 of 83 (22%) patients in the silastic drain group developed symptomatic effusion, whereas 46 of 63 (73%) patients in the chest tube group developed symptomatic effusion (p < 0.0001). The chest tube group had a significantly higher incidence of symptomatic pleural effusions than the Blake tube group. At a sample size of 146 our power to distinguish a difference between groups was 99.7%.
CONCLUSION: This study demonstrates that leaving a supplemental drain for 3-5 days post-CABG surgery is an adequate and cost-effective drainage method that reduces the incidence of symptomatic postoperative pleural effusions.
CLINICAL IMPLICATIONS: Clinically, the study shows that if a supplemental drain can be left in a patient post-operatively, it is not only an adequate and cost-effective drainage method but a convenience to the patient as well. The placement of a drain can prevent further occurrence of symptomatic postoperative pleural effusion, thus reducing further treatments such as diuretics, thoracentesis, tube thoracostomy, and operation.
DISCLOSURE: Murtaza Dawood, No Product/Research Disclosure Information; No Financial Disclosure Information