Promising Effects of Digital Chest Tube Drainage System for Pulmonary Resection: A Systematic Review and Network Meta-Analysis

Abstract

Objective: The chest tube drainage system (CTDS) of choice for the pleural cavity after pulmonary resection remains controversial. This systematic review and network meta-analysis (NMA) aimed to assess the length of hospital stay, chest tube placement duration, and prolonged air leak among different types of CTDS.

Methods: This systemic review and NMA included 21 randomized controlled trials (3399 patients) in PubMed and Embase until 1 June 2021. We performed a frequentist random effect in our NMA, and a P-score was adopted to determine the best treatment. We assessed the clinical efficacy of different CTDSs (digital/suction/non-suction) using the length of hospital stay, chest tube placement duration, and presence of prolonged air leak.

Results: Based on the NMA, digital CTDS was the most beneficial intervention for the length of hospital stay, being 1.4 days less than that of suction CTDS (mean difference (MD): -1.40; 95% confidence interval (CI): -2.20 to -0.60). Digital CTDS also had significantly reduced chest tube placement duration, being 0.68 days less than that of suction CTDSs (MD: -0.68; 95% CI: -1.32 to -0.04). Neither digital nor non-suction CTDS significantly reduced the risk of prolonged air leak.

Conclusions: Digital CTDS is associated with better outcomes than suction and non-suction CTDS for patients undergoing pulmonary resections, specifically 0.68 days shorter chest tube duration and 1.4 days shorter hospital stay than suction CTDS.

Keywords: chest tube drainage system; digital chest tube; lung resection; meta-analysis; network meta-analysis; pulmonary resection.

Figure 1

PRISMA flow diagram of the study selection. Flow diagram for the identification process of eligible studies.

Figure 2

Network structure of an outcome measure. The size of the nodes represents the number of objectives involved in the treatment approach. The numbers on the lines represent the number of comparisons between each treatment approach. (A) The length of hospital stay; (B) chest tube placement duration; (C) prolonged air leak.

Figure 3

Network meta-analysis of (A) the length of hospital stay, (B) the chest tube placement duration, as well as (C) the prolonged air leak. The most beneficial intervention for the length of hospital stay was digital CTDS, which was 1.4 days shorter than the suction CTDSs (MD: −1.40; 95% CI: −2.20 to −0.60). Digital CTDS also significantly reduced chest tube placement duration by 0.68 days compared to suction CTDS (MD: −0.68; 95% CI: −1.32 to −0.04). Neither digital (OR: 0.76; 95% CI: 0.42–1.39) nor non-suction (OR: 0.95; 95% CI: 0.56–1.62) CTDS significantly reduced the risk of prolonged air leak. CI, confidence interval; MD, mean difference; OD, odds ratio.

Figure 4

Rank-heat plot of P-score values among different chest tube drainage systems targeting the outcomes of length of hospital stay, chest tube placement duration, and prolonged air leak. Each slice of circle represents a different treatment. Treatments were ranked according to their P-score. A higher P-score (in green) denoted shorter hospital stay, shorter chest tube placement, and lower risk of prolonged air leak.