Chest tube removal after cardiac surgery in first vs. second post-operative day: a systematic review and meta-analysis.

BACKGROUND: The optimal timing of chest tube removal after cardiac surgery remains uncertain, with institutional practices varying widely. While early removal may promote faster recovery, concerns persist regarding potential complications such as fluid accumulation. This meta-analysis compares early versus late chest tube removal and their effects on clinical and procedural outcomes. METHODS: We searched Web of Science, SCOPUS, PubMed, and Cochrane Central Register of Controlled Trials until May 2025. Nine studies involving 8,557 patients were included. Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals were calculated using either random-effects or fixed-effects models. RESULTS: Early chest tube removal was associated with a significantly higher risk of pericardial effusion (RR 1.85, p = 0.0105), while pleural effusion showed an increasing trend with marginally significant difference (RR 1.19, p = 0.0584). Hospital stay was shorter in the early group (MD -1.00 days, p < 0.0001), yet ICU stay showed no meaningful difference (MD -7.25 h, p = 0.217). Mortality rates were comparable (RR 0.93, p = 0.8048). Similarly, no significant differences were observed in postoperative infection (RR 0.85, p = 0.4403) or atrial fibrillation rates (RR 1.01, p = 0.8649). CONCLUSION: Early chest tube removal appears safe with respect to mortality, infection, and atrial fibrillation, but is associated with a higher risk of pericardial effusion; adoption should therefore be risk-stratified and paired with post-removal surveillance.