Reply to McGuire and Gilbert

We thank McGuire and Gilbert for taking interest in our work on fast-tracking chest tube removal in video-assisted thoracic surgery (VATS) lobectomy [1, 2]. To clarify, the perioperative data included in our study were collected from an institutional database, whereas the 30-day followup included data on readmission from the ‘E-journal’, which can be considered a national database [2]. During the study period, the policy of our department, followed by all surgeons, was removal of chest tubes following VATS lobectomy if serous outputs were <500 ml in 24 h. Our study was a retrospective assessment of the consequences of this practice in the context of recurrent pleural effusions requiring an intervention [2]. We actually did review approximately 50 charts in an attempt to collect detailed data on the volumes of chest tubes in the last 24 h preceding removal, but the results were unsatisfactory due to lacking or imprecise documentation in the charts; therefore, we do not consider it feasible to conduct an institutional level chart review. However, we agree that it is highly relevant to define a more precise volume of chest tube outputs that may be predictive of recurrent pleural effusions, but this will not change the clinically relevant conclusion of our study that up to 500 ml/day can be accepted as a general minimum limit in adult patients after VATS lobectomy. Including collection of patient height and weight in a prospective study would allow for the calculation of expected daily productions of pleural fluid for the individual patients and might be interesting in future studies that look on the possibility to go beyond our present set limit.