To explore the feasibility and safety of early removal of chest tube after video-assisted thoracoscopic lung surgery and explore the indication of removal of chest tube.

117 patients were selected as the observation group who performed video-assisted thoracoscopic lung surgery in the department of cardiothoracic surgery from Nov. 2019 to Apr. 2020, in Drum Tower Hospital, affiliated with Nanjing University Medical School, and removed chest tube after operation early (in 48 hours). 114 patients with routine removal of chest tube were selected as the control group who performed video-assisted thoracoscopic lung surgery in the same hospital from Nov. 2018 to Apr.2019. Age (P=0.476), sex (P=0.216), surgical methods (P=0.715), mediastinal lymph node dissection or sampling (P=0.200), target lobes (P=0.925), pathological nature (P=0.957) were similar between the two groups. This retrospective study analyzed the postoperative clinical results, complications and recurrent pleural drainage after extubation between the two groups.

There were significant differences in the amount of drainage before extubation in 24 hours [(245.7±98.1)ml vs(120.8±46.8)ml, P<0.001], the time of drainage after operation [(43.9±2.6)h vs(84.5±10.5)h, P<0.001], hospitalization time of postoperative [(2.2±0.4)d vs(4.2±1.1)d, P<0.001], hospitalization cost [(53 000±4 000)yuan vs (56 000±3 000)yuan, P<0.001], the VAS score after extubation [(4.4±1.2) vs (3.3±1.2), P<0.001], and incidence of total complications after extubation (20.5% vs 10.5%, P=0.036) between the two groups. The VAS score before and after extubation in the observation group [(5.9±0.8) vs(4.4±1.2), P<0.001]and the VAS score before and after extubation in the control group [(6.0±0.9) vs (3.3±1.2), P<0.001]were statistically significant. The VAS score before extubation [(5.9±0.8) vs(6.0±0.9), P=0.464], the incidence of pneumothorax after extubation (1.7% vs 0.9%, P>0.999), pleural effusion (12.8% vs 6.1%, P=0.084), cutaneous emphysema (2.6% vs 1.8%, P>0.999), fever (3.4% vs 1.8%, P=0.703) and recurrent pleural drainage(2.6% vs 1.8%, P>0.999)were similar between the two groups.

Early removal of chest tube after video-assisted thoracoscopic lung surgery may increase the incidence of pleural effusion after extubation, however, early removal of chest tube can significantly reduce pain after operation, and does not increase the incidence of pneumothorax, cutaneous emphysema, and fever, nor increase the risk of recurrent pleural drainage. Therefore, it is safe and feasible to remove the chest tube early after video-assisted thoracoscopic lung surgery, which is beneficial to reduce the economic burden of patients, shorten the hospitalization days, and enhance recovery after surgery.