Comparison between electronic and traditional chest drainage systems: a multicenter randomized study

Background: Air leaks is the major factor which influences the permanence of the chest tube and the in-hospital length of stay (LOS) among patients undergoing lung resections. The aim of this study is to determine if the use of digital chest systems, compared with traditional ones, reduces the duration of chest drainage and postoperative in-hospital LOS in patients undergoing video-assisted thoracoscopy (VATS) lobectomy. Methods: The study is a prospective, randomized, multicenter trial. Patients undergoing VATS lobectomy were randomized in two groups, receiving either a digital drain system or a traditional one and managed accordingly to the protocol. Results: Among 503 patients who fulfilled inclusion criteria and were randomized, thirty-eight of them dropped out after randomization. Finally, 465 patients were analyzed: among them, 204 used the digital device and 261 the traditional one. In digital group there was a significantly shorter median chest tube duration (3 post-operative days, IQR 2-4,vs 4 post-operative days, IQR 3-4, p=0.001) and post-operative in-hospital LOS (4 post-operative days, IQR 3-6 vs 5 post-operative days, IQR 4-6, p=0.035). Analysis of predictors for increased duration of air leaks showed a relationship with male gender (p=0.039), forced expiratory volume in 1 second % (p=0.004), forced vital capacity % (p=0.03) and presence of air leaks at the end of surgery (p=0.001). Conclusions: In patients undergoing VATS lobectomy, the use of a digital drainage allows an earlier removal of the chest drain compared to the traditional system, leading to a shorter in-hospital LOS.