Abstract
BackgroundUniportal video-assisted thoracoscopic surgery (UniVATS) was utilized with a rapid growth. The evidence is sparse, however, on whether to add external suction to water-seal drainage for chest drainage after UniVATS. This retrospective propensity score-matched study aimed to identify the necessity of adding external suction to chest drainage after UniVATS.MethodsPatients with lung cancer who underwent UniVATS were included from our prospectively maintained database. Patients were divided into two cohorts based on the addition of external suction to postoperative water-seal drainage or not. Propensity score-matched analysis was performed to identify the impact of suction on chest tube duration, incidence of persistent air leak, hospital stay, and hospitalization cost. Multivariable model with interaction terms was constructed to identify impact of covariables on effect of suction.ResultsThe two cohorts matched well on baseline characteristics (nonsuction: 173; suction: 96). Compared with nonsuction group, suction group showed longer median chest tube duration (3 vs. 2 days, p = 0.003), higher incidences of persistent air leak (9.4% vs. 1.2%, p = 0.003), persistent drainage (16.8% vs. 5.8%, p = 0.007), and reduced drainage volume within first 3 postoperative days (386.90 vs. 504.78 ml, p = 0.011). Resection extent was identified to mediate the relationship between suction and chest tube drainage.ConclusionsThese findings discouraged adding external suction to water-seal drainage after UniVATS regarding longer chest tube duration and more persistent air leak. Patients undergoing lobectomy would benefit more from water-seal drainage without external suction compared with those doing sublobectomy.
Highlights
Simple water seal or addition of suction to simple water seal were routinely used for chest drainage after pulmonary surgery [1]
Uniportal video-assisted thoracoscopic surgery (UniVATS) has been experiencing rapid growth as a lessinvasive approach compared with multiportal VATS [6,7,8]
Suction drainage showed increased median chest tube duration compared with nonsuction drainage [3 days [2,3,4] vs. 2 days [2,3], p = 0.003] (Table 2)
Summary
Simple water seal (nonsuction drainage) or addition of suction to simple water seal (suction drainage) were routinely used for chest drainage after pulmonary surgery [1]. We previously found that the addition of suction to simple water seal increased chest tube duration following pulmonary surgery [5]. Uniportal video-assisted thoracoscopic surgery (UniVATS) has been experiencing rapid growth as a lessinvasive approach compared with multiportal VATS [6,7,8]. UniVATS was reported to result in shorter chest tube duration and less postoperative complications [2, 9, 10] It still needed further insight into this newly emerging approach. External suction on chest tube drainage, as part of perioperative management, is lack of evidence on its effect on patients’ postoperative outcomes after uniportal VATS. The evidence is sparse, on whether to add external suction to water-seal drainage for chest drainage after UniVATS.
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