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. 2021 Oct 26:11:751396.
doi: 10.3389/fonc.2021.751396. eCollection 2021.

Suction Versus Nonsuction Drainage After Uniportal Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Study

Jian Zhou  1 , Chuan Li  1 , Quan Zheng  1   2 , Chenglin Guo  1 , Mengyuan Lyu  3 , Qiang Pu  1 , Hu Liao  1 , Lunxu Liu  1
Affiliations

Suction Versus Nonsuction Drainage After Uniportal Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Study

Jian Zhou et al. Front Oncol. .

Abstract

Background: Uniportal 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.

Methods: Patients 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.

Results: The 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.

Conclusions: These 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.

Keywords: drainage; lung cancer; suction; surgery; uniportal.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Standardized mean differences of variables between suction and nonsuction groups. Black and grey dots represented standardized mean differences before and after matching, respectively. (B) Mirror histogram of propensity scores for suction group (above the x-axis) and nonsuction group (below the x-axis).
Figure 2
Figure 2
Results of multivariable regression analysis on the (A) chest tube duration and (B) incidence of PAL.
Figure 3
Figure 3
Subgroup analysis regarding extent of resection.
Figure 4
Figure 4
Subgroup analysis regarding (A) surgical duration and (B) intraoperative fibrin use.
Figure 5
Figure 5
Meta-analysis on effect of addition of suction on chest tube duration.
See this image and copyright information in PMC

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