This study assessed the safety of an early chest tube removal (CTR) protocol on the first postoperative day in an enhanced recovery after surgery (ERAS) program, focusing on patients undergoing elective coronary revascularization and/or valve surgery from 2015 to 2021. A propensity score matching compared outcomes between patients following the ERAS programme with early CTR and a control group receiving conventional care. The results showed no significant difference in the primary endpoint, which included postoperative complications such as pneumothorax, pleural and pericardial effusion requiring intervention, and hospital mortality, between the groups. The ERAS group experienced lower incidences of bronchopneumonia, and higher incidences of reduced mechanical ventilation time, shorter intensive care, and hospital stays, demonstrating that CTR on POD1 can be safely incorporated into ERAS programmes.