Background Postoperative drainage is essential in cardiac surgery to prevent tamponade, monitor bleeding, and maintain hemodynamic stability. Although large‐bore chest tubes have been traditionally used, small‐bore drains are gaining interest because of their potential benefits in reducing pain and improving recovery. However, their clinical impacts remain unclear. Objective To systematically map and evaluate the available evidence on the clinical outcomes of small‐bore versus conventional large‐bore chest tubes in adult patients undergoing cardiac surgery. Methods A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews guidelines. Four databases (PubMed, Embase, Cochrane CENTRAL, and Web of Science) were searched for studies published between January 2000 and July 2025. Eligible studies included randomized controlled trials (RCTs) and observational comparative studies comparing small‐bore drains (such as Blake, Jackson–Pratt, and Redon) and conventional chest tubes after cardiac surgery. The outcomes included drainage effectiveness, pain, complications (such as tamponade and reoperation), atrial fibrillation, and hospital stay. Two reviewers independently extracted the data, and the levels of evidence were assigned using the Oxford Center for Evidence‐Based Medicine 2011 framework. Owing to clinical heterogeneity, a qualitative synthesis was performed. Results Twelve studies comprising 3206 patients were included, of which nine were RCTs and three were retrospective studies. Most studies used Blake drains as the small‐bore device. Two studies reported significantly reduced postoperative pain in the small‐bore group and two reported lower analgesic use. Drainage volumes, reoperation rates, and late effusion rates did not significantly differ between groups in most studies. Cardiac tamponade and atrial fibrillation were less frequent in the small‐bore group in two studies. Hospital and intensive care unit stays showed no consistent trends. No studies demonstrated inferiority of small‐bore drains in clinical outcomes. Conclusion This scoping review found that small‐bore drains are safe and clinically comparable alternatives to large‐bore chest tubes in cardiac surgery. Given the potential advantages of patient comfort, the broader use of small‐bore drains may be justified.
Cho et al. (Thu,) studied this question.