Air Leak Management in the Digital Age—We Still Need to Decipher the Data

In this issue of The Annals of Thoracic Surgery, the findings of the multiinstitutional study by Adachi and colleagues 1 Adachi H. Wakimoto S. Ando K. et al. Optimal chest drainage method after anatomic lung resection: a prospective observational study. Ann Thorac Surg. 2023; 115: 845-853 Abstract Full Text Full Text PDF Scopus (2) Google Scholar highlight the ongoing challenges in adopting one optimal chest tube management strategy after lung resection. In their study, they reported increased air leak duration using the digital drainage system (4.0 days) compared with patients with air leaks that were managed by traditional water seal (2.5 days) or continuous negative-pressure suction (3.0 days). Clinically, patients in the digital drainage cohort kept their chest tubes on average 2 days longer than those managed by the traditional approaches (6.0 days vs 4.0 days). 1 Adachi H. Wakimoto S. Ando K. et al. Optimal chest drainage method after anatomic lung resection: a prospective observational study. Ann Thorac Surg. 2023; 115: 845-853 Abstract Full Text Full Text PDF Scopus (2) Google Scholar These findings differ from earlier studies, which found that using digital drainage systems promoted earlier chest tube removal and were associated with decreased length of stay after lung resection. 2 Filosso P. Nigra V. Lanza G. et al. Digital versus traditional air leak evaluation after elective pulmonary resection: a prospective and comparative mono-institutional study. J Thorac Dis. 2015; 7: 1719-1724 PubMed Google Scholar , 3 Brunelli A. Salati M. Di Nunzio L. et al. Evaluation of a new chest tube removal protocol using digital air leak monitoring after lobectomy: a prospective randomized trial. Eur J Cardiothorac Surg. 2010; 37: 56-60 Crossref PubMed Scopus (109) Google Scholar , 4 Pompili C. Detterbeck F. Papagiannopoulos K. et al. Multicenter international randomized comparison of objective and subjective outcomes between electronic and traditional chest drainage systems. Ann Thorac Surg. 2014; 98: 490-497 Abstract Full Text Full Text PDF PubMed Scopus (127) Google Scholar Yet, relevant differences in those patients studied from the present study deserve mentioning. Those investigations examined digital systems for chest tube management independent of air leak status, whereas Adachi and coworkers 1 Adachi H. Wakimoto S. Ando K. et al. Optimal chest drainage method after anatomic lung resection: a prospective observational study. Ann Thorac Surg. 2023; 115: 845-853 Abstract Full Text Full Text PDF Scopus (2) Google Scholar specifically excluded patients who did not have an air leak detected on postoperative day 1. This excluded 76% of the 1470 patients who underwent anatomic lung resections during their study period. Without the chest tube outcomes in this larger group, readers should remain cautious about drawing firm conclusions regarding the most cost-effective approach of chest tube management for an inpatient service. Optimal Chest Drainage Method After Anatomic Lung Resection: A Prospective Observational StudyThe Annals of Thoracic SurgeryVol. 115Issue 4PreviewSeveral methods for chest drainage after pulmonary resection of malignant lung tumors exist, but consensus on the ideal method has not been reached. Full-Text PDF