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Assessment of Postoperative Chylothorax Volume Threshold Associated with Failed Conservative Management.

Assessment of Postoperative Chylothorax Volume Threshold Associated with Failed Conservative Management. The Annals of thoracic surgery Lin, N., Kapula, N., Wallen, B., Kim, J., Manapat, P., Kamtam, D., Guenthart, B., Elliott, I., Lui, N., Backhus, L., Shrager, J., Berry, M., Liou, D. Z. 2025

Abstract

BACKGROUND: Management of postoperative chylothorax typically involves a stepwise strategy of initial conservative management followed by lymphangiography and re-operation when conservative management fails. This study tested the hypothesis that high-volume chylothorax drainage over the first 48 hours is associated with failure of conservative management.METHODS: Our institutional database was queried for patients who developed chylothorax following lung, foregut, or mediastinal surgery and underwent initial conservative management between 2009 and 2024. Patients were stratified according to whether the chylothorax resolved with conservative management versus intervention with lymphangiography and/or re-operation. Daily thoracostomy tube drainage was evaluated, and a 48-hour chylothorax volume cut-off point associated with failure of conservative management was calculated by using Youden's index from the receiver operating characteristic (ROC) curve. Predictors of failed conservative management were estimated using multivariable logistic regression.RESULTS: Seventy-seven patients experienced postoperative chylothorax, including 43 (56%) after lung resection, 22 (29%) after esophageal surgery, and 12 (16%) after mediastinal surgery. Forty-eight (62%) patients were successfully managed conservatively while 29 (38%) patients required intervention. Daily chylothorax drainage was significantly lower in patients who required conservative management. The area under the ROC curve was 0.75, and the 48-hour chylothorax volume cut-off point was 1,110 mL based on Youden's index. This cut-off was associated with a nearly 4-fold increased risk of failed conservative management (AOR 3.84, p=0.023).CONCLUSIONS: Patients who develop postoperative chylothorax with drainage >1,100 mL over the first 48 hours should be considered for early intervention with lymphangiography or re-operation given the likelihood of failing conservative management.

View details for DOI 10.1016/j.athoracsur.2025.10.015

View details for PubMedID 41203002