BACKGROUND: chest tube insertion is recommended after cardiac surgery, and chest tube inserted annually for a large number of these patients. In addition to its benefits, the chest tube may have risks that are mismanaged. One of these risks is the possibility of pleural effusion, which involves relatively high rates. Therefore, we conducted a systematic review to properly manage the chest tube and reduce its complications. METHODS: This systematic review of cohort study asked the question: Is there enough evidence to determine the right time to remove the chest tube? We search ISI Web of Science, PubMed, Scopus and Embase through 1 January 2015 to 30 September 2019 to identify retrospective or prospective cohort studies. RESULTS: Three studies of the studies reviewed recommended early chest tube removal and two studies recommending delaying. Of course, early and late in the studies had different meanings and time frames that were examined. CONCLUSIONS: More and more evidence and studies are needed to determine the right timing and management of the chest tube removal but our systematic review is based on the available evidence revealed that if the chest tube removal occurs about 24 hours postoperatively, and with less than 100 ml drainage within the last 8 hours, it reduced the risk of pleural effusion and improve many other outcomes.