INTRODUCTION
The importance of chest tube insertion after open-heart surgery is not covered. Chest tube insertion is routine after heart surgery, according to statistics published by the International Classification of Diseases, chest tube placement is performed annually for 133,000 US hospitalized patients, that is contemplative1,2 and yet there is no guideline for management of chest tube removal.3Proper management of chest tube improves factors such as reduced pericardial and pleural effusion rates, decreases patient pain, chest tube replacement, and length of hospital stay, and on the other hand, it improves respiratory status and many more.3-5 Given the fact that timely management of chest tube removal has many benefits and there are indeed prediction models for heart surgery6,7 but there is controversy over the right time for nurses and surgeons because these models are not specific and practical.8-10 For example, some surgeons find it helpful from the empirical evidence to remove the chest tube early, and others believe that delaying it has more benefits.11This is strongly influenced by the fact that perhaps there is a lack of credible evidence and research about this issue.12-14However, we know that pleural effusion is likely after the chest tube removal, but there is no consensus on the choice of the appropriate diagnostic test to identify pleural effusion.15,16This is another reason that makes it difficult to decide the right time to chest tube removal. It has even been suggested that taking X-ray after chest tube removal does not help the patient’s management and is recommended in the presence of clinical symptoms.17-19
Given the above, it is difficult to make decisions about the timing of chest tube removal, so the present systematic review aimed to compare the effect of early and late chest tube removal on pleural effusion in patients undergoing coronary artery bypass graft surgery.