THE IMPACT OF CHEST TUBE PLACEMENT TECHNIQUES ON ATRIAL FIBRILLATION DURING CORONARY BYPASS SURGERY

Introduction: Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG), with incidence rates reported between 20% and 40%. Pain and hypoxia related to intercostal chest tube placement may play a role in the development of POAF. This study sought to compare the impacts of midaxillary intercostal versus subxiphoid chest tube placement on the development of postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass. Methods: A retrospective, single-center study was performed involving 675 patients who underwent isolated coronary artery bypass grafting (CABG) utilizing the left internal mammary artery (LIMA) from January 2021 to March 2025. Patients were categorized into two groups: Group 1 (n=442) underwent midaxillary intercostal drainage, while Group 2 (n=233) received subxiphoid drainage. The two groups were similar in terms of demographic and perioperative factors. The primary outcome was the occurrence of POAF; secondary outcomes encompassed postoperative pain scores, oxygenation metrics, and drainage efficacy. Results: POAF manifested in 34.2% of Group 1 and 18% of Group 2 (p<0.05). Subxiphoid drainage was correlated with elevated postoperative arterial pO₂ (82 vs. 74 mmHg; p=0.042), reduced pCO₂ (38 vs. 42 mmHg; p=0.025), and diminished pain scores (VAS 5 vs. 8; p=0.002). Group 2 also used a lot less pain medicine. There was no significant difference in the effectiveness of drainage or the rates of pleural effusion. Conclusion: Subxiphoid chest tube placement following CABG is linked to diminished pain, enhanced oxygenation, and markedly lower rates of postoperative atrial fibrillation (POAF) in comparison to intercostal placement. This method is a simple, flexible way to improve postoperative results, and it should be included in CABG surgical protocols.