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Background: Patients with thoracic empyema occasionally require chest tubes for drainage. Several studies have reported that smaller chest tubes are effective and cause fewer complications. The aim of this study was to investigate the outcomes of patients with empyema who underwent drainage using a smaller-size chest tube. Methods: We retrospectively reviewed all patients at 2 institutions with thoracic empyema. We performed both univariate and multivariate analysis to examine the relation between tube size and the incidence of complications. Results: The mean chest-tube size was 22 ± 3.0 Fr. Six patients (12%) died within 90 days of tube insertion. Three patients (5.9%) required surgery. A total of 31 complications were recorded during the duration of drainage. On univariate analysis, a chest-tube size either greater than 20 Fr or greater than 22 Fr was significantly associated with the incidence of complications (OR, 4.90; 95% CI, 1.45-16.6; and OR, 4.75; 95% CI, 1.37-16.5, respectively). On multivariate analysis, a chest drain larger than 20 Fr (OR, 4.51; 95% CI, 1.27-16.3; P = 0.020) was significantly related to the incidence of adverse events during chest drainage. Treatment failure and death were not significantly increased in the population of patients with chest tubes smaller than 20 Fr, and the duration of drainage and of hospital admission was not extended in these patients. Conclusions: Chest tubes smaller than 20 Fr may reduce complications included pain in patients with thoracic empyema. Furthermore, outcomes of chest drainage are similar for tubes larger than and smaller than 20 Fr. Further prospective studies examining various chest-tube sizes are required to validate our results.

Drainage using Chest Tubes Smaller than 20 French is Suitable for Patients with Thoracic Empyema