BOB in Ped Surg 2023 - PAPS Winner - Jamie Schnuck, MD

Plural drainage is nearly universally practiced in pediatric patients following lung resection

Routine chest tube placement is often associated with increased pain, anxiety, additional chest x-rays, and may prolong hospitalizations

Adult literature shows elimination of routine chest tubes as part of enhanced recovery after surgery (ERAS) pathways in select patients

In lobectomy patients (n=59), nearly 75% did not have an air leak noted post-operatively, with median chest tube duration of two days

In lobectomy patients with documented air leak (n=15), median chest tube duration was also two days

In diagnostic wedge resection patients (n=19), nearly 90% did not have an air leak post-operatively, with median chest tube duration of one day

In excisional wedge resection patients (n=52), 80% did not have an air leak post-operatively, with median chest tube duration of one day

Overall, 43% of patients had chest tube removed on post-op day one, 22% on post-op day two, and 25% had chest tube left in place for documented air leak

Chest tube duration following lung resection in children is typically brief with removal within one to two days post-operatively

Avoidance of chest tube placement may reduce post-operative pain and hospital length of stay

A previous study titled 'Chest Tubes not necessary in wedge biopsies' showed good outcomes in a cohort where no chest tubes were used

The critical concern is not the number of patients who don't need chest tubes, but what happens to those who did need it but didn't receive one

Even if there is a leak after wedge resection, it would likely be small

The need for chest tubes depends on the type of surgery, with clean lobectomy versus cases with infection having different risk profiles

The focus should shift from determining if eliminating chest tubes is feasible to identifying which specific patients will need them