On-pump CABG performed without pleural drain placement appears to be safe and does not increase postoperative complications, while significantly reducing analgesic requirements and improving patient comfort.
Key Findings
Results
Patients who received only a mediastinal drain (no pleural drain) after on-pump CABG with left internal mammary artery grafting needed significantly fewer NSAID doses than patients who received both mediastinal and pleural drains.
NSAID consumption was 3.04 ± 1.25 doses in Group 1 (mediastinal drain only) versus 3.95 ± 1.50 doses in Group 2 (mediastinal plus intercostal pleural drain).
The difference was reported as significant at p < 0.001.
Retrospective analysis of 207 patients: Group 1 n = 100, Group 2 n = 107.
Results
Opioid requirements were significantly lower in the single-drain (mediastinal only) group than in the group with an added pleural drain.
Opioid consumption was 1.33 ± 1.29 doses in Group 1 versus 2.23 ± 1.45 doses in Group 2.
The difference was reported as significant at p < 0.001.
The authors interpret lower analgesic use as improved postoperative comfort.
Results
Pulmonary complications and mortality were comparable between patients with and without a pleural drain.
Pulmonary outcomes and mortality were compared between the two cohorts and did not differ.
Omitting the pleural drain did not increase postoperative complications.
The study compared postoperative complications, pulmonary outcomes and mortality in 207 patients.
Results
The two groups were similar in preoperative characteristics and operative variables, supporting comparability of the cohorts.
Patients underwent elective on-pump CABG with the left internal mammary artery between January 2016 and December 2020.
Group 1 (n = 100) received a mediastinal drain only; Group 2 (n = 107) received mediastinal and intercostal pleural drains.
Design was a retrospective cohort study, so group allocation was not randomised.
Conclusions
The authors conclude that on-pump CABG without pleural drain placement is safe and improves patient comfort.
The approach reduced analgesic requirements without increasing postoperative complications.
The study aimed to evaluate whether omitting the pleural drain reduces pain and pulmonary complications.
What This Means
This study looked back at records of 207 people who had planned coronary artery bypass surgery using a heart-lung machine and a chest wall artery graft (the left internal mammary artery) between 2016 and 2020. About half (100 patients) had only one drain placed behind the breastbone, while the others (107) also had a second drain placed in the side of the chest next to the lung. The two groups were similar before and during surgery.
Patients who had only the single drain needed noticeably fewer pain medicines afterwards. They used about 3 doses of anti-inflammatory painkillers versus about 4, and about 1.3 doses of opioids versus about 2.2. Rates of lung-related complications and deaths were similar in both groups.
This research suggests that leaving out the extra chest-side drain may be a safe way to make recovery more comfortable for some bypass patients. However, because the study was retrospective and not a randomised trial, and was done at a limited number of centres, larger prospective studies would be needed to confirm these results. Decisions about drains are best made by surgical teams for each patient.
Kumtepe G, Güven H. (2026). Safety and patient comfort after coronary artery bypass surgery: Conventional versus single-drain - a retrospective cohort study.. Cardiovascular journal of Africa. https://doi.org/10.5830/CVJA-2026-042