Review of patients discharged post thoracic surgery with chest drain in situ and nurse-based follow-up clinic.

ABSTRACT

Persistent air leak and prolonged drainage are recognized complications of thoracic surgery, increasing hospital stay and costs. Patients can be discharged with a chest drain and followed up in a nurse-led clinic. We reviewed such patients and the rate of readmission after discharge to assess the effectiveness of the drain follow up clinic. Retrospective review of our prospective database for 22 months (March 2019 to January 2021). Analysis focussed on indication and duration of chest drainage, complications, and readmission for any reason. 62 patients (representing 5% of all thoracic surgery patients) were discharged with a chest drain. Median age was 67 years (range 22-85 years), 24 females and 38 males. 52% underwent video-assisted thoracoscopic surgery, 27% had a thoracotomy, and 21% had bedside chest drain insertion. Following discharge, median duration of chest drainage was 11 days [interquartile range (IQR) 7-18.75 days]. Patients had 106 review episodes in the ward-based nurse-led clinic. Indication was prolonged air leak (71 %; 72 clinic reviews), persistent fluid drainage following empyema evacuation (16%; 24 clinic reviews) and persistent fluid drainage for simple effusion (13%; 10 clinic reviews). Median length of drain stay was 30 days (IQR 19.75-54 days) for empyema, 10 days (IQR 6-16 days) for air leak and 8 days (IQR 6.5-12 days) days for simple effusion. 9 patients required readmission (14.5%) and empyema had developed in 3 patients (4.8%). Patients discharged with a chest drain in place can be followed up in a dedicated ward-based nurse-led monitoring clinic for optimal quality of care.