A propensity sore‐matched study: Applying a modified chest tube drainage strategy in rapid rehabilitation following uni‐portal thoracoscopic pulmonary wedge resection

Abstract

PurposeThis study aimed to compare the value of a modified chest tube drainage strategy to a traditional drainage strategy in single‐port thoracoscopic pulmonary wedge resection.MethodsFrom January 2019 to July 2021, we collected clinical data on 405 patients who underwent single‐port thoracoscopic pulmonary wedge resection in the No.1 Department of Thoracic Surgery at Fujian Medical University Union Hospital, with 121 (29.9%) cases in the modified drainage strategy group and 284 (70.1%) cases in the traditional drainage strategy group. The propensity score matching method (Match Ratio = 1:1) was used to reduce differences in clinical characteristics between the two groups.ResultsFollowing 1:1 propensity score matching, 120 matched pairs (240 patients) were included in the study. There was no significant difference in general clinical characteristics between the two groups. There was no statistical difference in intraoperative factors except for operative times (71.42 ± 22.98 min vs. 86.80 ± 36.75 min, p < 0.001). In terms of postoperative factors, there were significant differences in postoperative chest tube duration (0.00 ± 0.00 h vs. 32.68 ± 18.51 h, p < 0.001), total drainage volume (143.03 ± 118.33 ml vs. 187.73 ± 140.82 ml, p = 0.008), postoperative hospital stay (2.61 ± 0.70 days vs. 3.27 ± 1.88 days, p < 0.001), number of additional pain relief (0.14 ± 0.40 vs. 0.42 ± 0.74, p < 0.001), facial pain score (2.7 ± 1.8 vs. 3.6 ± 2.7, p = 0.005) and adverse events (p = 0.046). Furthermore, there was a statistical difference between the two groups regarding CTCAE grade‐1 complication, but no statistical difference in CTCAE grade‐2 complication.ConclusionsA modified drainage strategy in single‐port thoracoscopic pulmonary wedge resection is safe and feasible, allowing for less postoperative rehabilitation time, pain relief, reduced postoperative pleural effusion, and reduced clinical workload.

Editorial: Early chest drain removal following lung resection

“…Another method which was widely performed was the temporary insertion of a chest drain inside the pleural cavity (10,11,22,(24)(25)(26)(27)(28)(30)(31)(32)(33). After closing all the intra-operative chest wall incisions, the drain was subsequently either connected to a digital suction system with negative suction (24, 27, 28, 30, 31,35) or its extra-thoracic end was simply immersed to a bowl with sterile water (10,11,22,32) while the anesthetic team administered manually positive inspiratory pressures. Then if there was no air leak by both the anesthesiologist assessment of volume delivered and returned and by the digital air leak meter attached to the chest tube the chest drain was removed before extubation.…”

“…Then if there was no air leak by both the anesthesiologist assessment of volume delivered and returned and by the digital air leak meter attached to the chest tube the chest drain was removed before extubation. In some studies, the investigators decided to leave either a central line or an ABLE catheter within the chest as a safety net to evacuate excess air of fluid if required (21,22,32,33). The size of the temporary chest drain ranged from 12 Fr to 24 Fr while in two cases the researchers used a nasogastric tube (19) and a Ryles' tube (11) to assess intra-operatively the presence of air leak.…”

Are the Efficacy and Safety of Chest Tubes in Uniportal Video-Assisted Thoracic Surgery Related to the Level of Intercostal Space Insertion or to the Drain Type? A Prospective Multicenter Study

“…Additionally, the insertion of a single chest tube through a high and antigravity space, straight to the apex of the thorax, is often criticized due to the possibility of inadequate drainage of the thoracic cavity, resulting in residual pleural effusion or insufficient lung re-expansion with residual pneumothorax. This may be more evident after upper lobectomies, where the risk of an empty pleural space in the apex is potentially higher and the necessity of good chest drainage becomes mandatory [12,13] to prevent any post-operative complications.…”

“…Therefore, while the efficacy and safety of the uniportal VATS technique for major lung resections were demonstrated in recent studies [9,14], the effectiveness of chest tube insertion through the same incision space is still debated due to the aforementioned potential risks [12,13].…”

“…Some studies [12,13,15] proposed possible solutions, such as the use of two chest tubes through the uniportal VATS incision [12], or the use of an additional pleural catheter (16 GA CVC) inserted in the VII/VIII intercostal spaces alone [12], or associated with the insertion of a single chest tube through the uniportal VATS incision [13].…”