Abstract
Introduction: Digital thoracic drainage systems are a new technology in minimally invasive thoracic surgery. However, the criteria for chest tube removal in digital thoracic drainage systems have never been evaluated. We aim to investigate the incidence and predictive factors of complications and reinterventions after drainage tube removal in patients with a digital drainage system. Method: Patients who received lung resection surgery and had their chest drainage tubes connected with a digital drainage system were retrospectively reviewed. Results: A total of 497 patients were monitored with digital drainage systems after lung resection surgery. A total of 175 (35.2%) patients had air leak-related complications after drainage tube removals, whereas 25 patients (5.0%) required reintervention. We identified that chest drainage duration of five days was an optimal cut-off value in predicting air leak-related complications and reinterventions. In multiple logistic regression analysis, previous chest surgery history; small size (16 Fr.) drainage tubes; the presence of initial air leaks, defined as air leaks recorded by the digital drainage system immediately after operation; and duration of chest drainage ≥5 days were independent factors of air leak-related complications, whereas the presence of initial air leaks and duration of chest drainage ≥5 days were independent predictive factors of reintervention after drainage tube removal. Conclusion: Air leak-related complications and reinterventions after drainage tube removals happened in 35.2% and 5.0% of patients with digital thoracic drainage systems. The management of chest drainage tubes in patients with predictive factors, i.e., the presence of initial air leaks and duration of chest drainage of more than five days, should be treated with caution.
Highlights
Digital thoracic drainage systems are a new technology in minimally invasive thoracic surgery
Based on our observational data, we analyze the incidences of post-tube removal complications and factors associated with reinterventions, which would improve decision-making for chest drainage tube removals in patients with digital thoracic drainage systems
The factors associated with air leak-related complications are shown in Table 1 and included male gender; smoking history, previous chest surgery history; poor forced expiratory volume in one second (FEV1); multi-port video-assisted thoracoscopic surgery (VATS) or thoracotomy; lobectomy; larger size of drainage tubes; lower suction pressure (≤−10 cmH2O); presence of initial air leaks, which is defined as air leaks by digital thoracic drainage systems immediately after operation; longer duration of chest drainage; and diagnosis of primary lung cancer
Summary
Digital thoracic drainage systems are a new technology in minimally invasive thoracic surgery. Conclusion: Air leak-related complications and reinterventions after drainage tube removals happened in 35.2% and 5.0% of patients with digital thoracic drainage systems. The incidence of air-leak-related complications after chest drainage tube removal in patients with digital thoracic drainage systems and the predictive factors for the need for reinterventions remain unclear. The purpose of this paper is to review our experience using digital thoracic drainage systems in patients after lung resection surgery, with emphasis on patient outcome after drainage tube removal. Based on our observational data, we analyze the incidences of post-tube removal complications and factors associated with reinterventions, which would improve decision-making for chest drainage tube removals in patients with digital thoracic drainage systems
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