Application of digital thoracic drainage system in patients with air leak after pulmonary resection: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIE Man , LIN Yue , ZHOU Yong , ZHAO Gefei , DAI Bo ,  YU Ao

Department of Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210000, P. R. China;

Corresponding?author：

YU Ao, Email: yuaosc@163.com

Keywords：

Digital thoracic drainage system; prolonged air leakage; pulmonary resection; perioperative management; closed thoracic drainage; complications; enhanced recovery after surgery

DOI：

10.7507/1007-4848.202601013

Video：

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Objective To investigate the application effect of digital chest drainage system in patients with air leak after lung resection and evaluate its efficacy and safety. Methods Clinical data of patients who underwent lung resection and received closed thoracic drainage postoperatively in the Department of Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2024 to November 2025 were collected. Patients with air leak graded Ⅰ to Ⅲ were divided into an experimental group (digital chest drainage system) and a control group (traditional closed thoracic drainage) according to different drainage devices used. Baseline characteristics and perioperative data were retrospectively analyzed and compared between the two groups. Results A total of 170 patients were included, with 81 in the experimental group (59 males, 22 females; median age 68 years) and 89 in the control group (60 males, 29 females; median age 68 years). There were no statistically significant differences between the two groups in terms of age, gender, body mass index, surgical type, pleural adhesions, surgical site, lesion nature, comorbidities, smoking index, or air leak grade (P>0.05). The experimental group had significantly less median total drainage volume [490 (883) mL vs. 740 (958) mL, P=0.023], shorter air leak duration [5 (2) d vs. 5 (4) d, P=0.005] and postoperative hospital stay [5 (1) d vs. 6 (4) d, P=0.029]. However, there were no statistically significant differences in hospitalization costs or drainage volume within the first 7 postoperative days between the two groups (P>0.05). The incidence of subcutaneous emphysema was significantly lower in the experimental group (27.16% vs. 41.57%, P=0.049). No significant differences were found between the groups in the incidence of pulmonary infection, atelectasis, pleural effusion, skin incision issues, secondary tube placement, or pain scores (P>0.05). Subgroup analysis revealed that for patients with grade Ⅰ air leak, the experimental group showed shorter air leak duration [5 (2) d vs. 5 (5) d, P=0.006] and postoperative hospital stay [5 (2) d vs. 6 (4) d, P=0.010] compared to the control group, with no significant difference in total drainage volume (P=0.055). For patients with grade Ⅱ air leak, there were no significant differences in total drainage volume, air leak duration, or postoperative hospital stay between the two groups (P>0.05). For patients undergoing wedge resection, the experimental group had less total drainage volume [289 (707) mL vs. 880 (1074) mL, P=0.035] compared to the control group, while no significant differences were found in air leak duration or postoperative hospital stay (P>0.05). For patients undergoing segmentectomy, there were no significant differences in total drainage volume, air leak duration, or postoperative hospital stay between the two groups (P>0.05). For patients undergoing lobectomy, the experimental group had shorter air leak duration [5 (2) d vs. 6 (4) d, P=0.029] compared to the control group, while no significant differences were found in total drainage volume or postoperative hospital stay (P>0.05). Conclusion Compared with traditional closed thoracic drainage, the digital chest drainage system effectively shortens the duration of postoperative air leak and hospital stay, reduces total drainage volume, and lowers the incidence of subcutaneous emphysema without increasing total hospitalization costs. It is a safe and effective drainage method for pulmonary resection patients, particularly those with grade Ⅰ air leak following lobectomy.

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	Lapidot M, Levy FD, Bueno R. Prolonged air leak after lung surgery: prevalent complication without a perfect solution. J Thorac Dis, 2023, 15(10): 5285-5286.
3.	Hoeijmakers F, Hartemink KJ, Verhagen AF, et al. Variation in incidence, prevention and treatment of persistent air leak after lung cancer surgery. Eur J Cardiothorac Surg, 2021, 61(1): 110-117.
4.	張瑛. 數字化胸腔閉式引流系統在心胸外科手術病人中的應用進展. 護理研究, 2022, 36(14): 2555-2558.Zhang Y. Application progress of digital drainage system in patients undergoing cardiothoracic surgery. Chin Nurs Res, 2022, 36(14): 2555-2558.
5.	中國醫師協會胸外科醫師分會, 海峽兩岸醫藥衛生交流協會胸外科專業委員會, 吳階平醫學基金會肺癌專業委員會, 等. 胸部手術圍術期持續性肺漏氣管理策略全國專家共識 (2023). 中華胸心血管外科雜志, 2024, 40(4): 193-200.Chinese Medical Doctor Association Thoracic Surgeon Branch, Wu Jieping Medical Foundation Lung Cancer Professional Committee, China Anti-Cancer Association Lung Cancer Integrated Rehabilitation Professional Committee, et al. Management strategies for persistent pulmonary air leak in the perioperative period of thoracic surgery: national expert consensus (2023). Chin J Thorac Cardiovasc Surg, 2024, 40(4): 193-200.
6.	Attaar A, Luketich JD, Schuchert MJ, et al. Prolonged air leak after pulmonary resection increases risk of noncardiac complications, readmission, and delayed hospital discharge: a propensity score-adjusted analysis. Ann Surg, 2021, 273(1): 163-172.
7.	Honda T, Tauchi S. Chest drainage outcomes by water seal versus low suction on digital thoracic drainage systems after lung resection: retrospective study. J Thorac Dis, 2024, 16(10): 6644-6650.
8.	Cerfolio RJ. Chest tube management after pulmonary resection. Chest Surg Clin N Am, 2002, 12(3): 507-527.
9.	中華醫學會呼吸病學分會胸膜與縱隔疾病學組(籌). 胸腔積液診斷的中國專家共識. 中華結核和呼吸雜志, 2022, 45(11): 1080-1096.Pleural and Mediastinal Diseases Working Group (Preparatory) of Chinese Thoracic Society. Chinese expert consensus on diagnosis of pleural effusion. Chin J Tuberc Respir Dis, 2022, 45(11): 1080-1096.
10.	Gioutsos K, Rieder O, Galanis M, et al. Risk factors for prolonged air leak after uniportal anatomical segmentectomy. Eur J Cardiothorac Surg, 2025, 67(3): ezaf030.
11.	賀高升, 何明, 朱輝. 數字胸腔引流系統在肺切除術中的應用價值. 中國腫瘤臨床, 2024, 51(2): 94-97.He GS, He M, Zhu H. The application value of digital thoracic drainage system in pneumonectomy. Chin J Clin Oncol, 2024, 51(2): 94-97.
12.	Duron G, Backer E, Feller-Kopman D. Evaluation and management of persistent air leak. Expert Rev Respir Med, 2023, 17(10): 865-872.
13.	Tsubokawa N, Mimae T, Ito R, et al. Effectiveness of pleurodesis for postoperative air leaks after lung resection. J Cardiothorac Surg, 2024, 19(1): 2.
14.	Hong JI, Lee JH, Kim HK. Early pleurodesis for postoperative air leak with autologous blood and 50% glucose solution. J Chest Surg, 2023, 56(1): 16-22.
15.	Taniguchi J, Aso S, Jo T, et al. Comparison between OK-432 and talc for pleurodesis in patients with persistent pulmonary air leak: a Japanese nationwide retrospective database study. Gen Thorac Cardiovasc Surg, 2025, 73(6): 428-435.
16.	樊榕榕, 李華艷, 陳思思, 等. 數字化胸腔引流系統在胸腔鏡肺切除術后應用的臨床價值. 中國微創外科雜志, 2021, 21(1): 13-17.Fan RR, Li HY, Chen SS, et al. Clinical value of digital drainage device in patients after thoracoscopic lung resection. Chin J Minim Invasive Surg, 2021, 21(1): 13-17.
17.	邊梅, 師文, 楊鑫. 便攜式數字智能胸腔引流系統的開發與研制. 中國醫療設備, 2023, 38(6): 43-49.Bian M, Shi W, Yang X. Development of portable digital intelligent thoracic drainage system. China Med Devices, 2023, 38(6): 43-49.
18.	Palleiko BA, Singh A, Strader C, et al. Clinical outcomes and staff satisfaction after adoption of digital chest drainage system for minimally invasive lung resections. J Thorac Dis, 2024, 16(5): 2963-2974.
19.	Comacchio GM, Marulli G, Mendogni P, et al. Comparison between electronic and traditional chest drainage systems: a multicenter randomized study. Ann Thorac Surg, 2023, 116(1): 104-109.
20.	Qian J, Guo F, Chen M, et al. Risk factor analysis and predictive model development for air leakage after thoracoscopic pulmonary wedge resection. J Thorac Dis, 2024, 16(10): 6806-6819.
21.	Lee JY, Lee J, Javakijkarnjanakul V, et al. Impact of postoperative prolonged air leakage on long-term pulmonary function after lobectomy for lung cancer. J Chest Surg, 2024, 57(6): 511-518.
22.	曹旭, 張新宇, 施月仙. 數字化胸腔引流系統對胸腔鏡肺部手術后應用效果的Meta分析. 護理實踐與研究, 2023, 20(4): 554-560.Cao X, Zhang XY, Shi YX. Meta-analysis of the application effect of digital thoracic drainage system after thoracoscopic pulmonary surgery. J Nurs Pract Res, 2023, 20(4): 554-560.
23.	Ibrahim Farag GA, Abdelfadil Ibrahim M, Abd Alaziz Al Awady RS, et al. Efficacy of digital vs. traditional chest drainage systems in postoperative care following pulmonary resection: a meta-analysis. Chirurgia, 2025, 38(5): 331-338.
24.	Chang PC, Chen KH, Jhou HJ, et al. Promising effects of digital chest tube drainage system for pulmonary resection: a systematic review and network meta-analysis. J Pers Med, 2022, 12(4): 512.
25.	Thakur S, Kashyap NK, Saurabh G, et al. Evaluation of the efficacy of a digital chest drainage system in traumatic pneumothorax. Cureus, 2023, 15(6): e41188.
26.	Barozzi L, Biagio LS, Meneguzzi M, et al. Novel, digital, chest drainage system in cardiac surgery. J Card Surg, 2020, 35(7): 1492-1497.
27.	Geraci TC, Sorensen A, James L, et al. Use of a novel digital drainage system after pulmonary resection. J Thorac Dis, 2022, 14(9): 3145-3153.
28.	Lee SA, Kim JS, Chee HK, et al. Clinical application of a digital thoracic drainage system for objectifying and quantifying air leak versus the traditional vacuum system: a retrospective observational study. J Thorac Dis, 2021, 13(2): 1020-1035.
29.	Nakada T, Ohtsuka T. Thoracic drain management using a digital system. J Thorac Dis, 2023, 15(2): 219-222.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Lapidot M, Levy FD, Bueno R. Prolonged air leak after lung surgery: prevalent complication without a perfect solution. J Thorac Dis, 2023, 15(10): 5285-5286.
3. Hoeijmakers F, Hartemink KJ, Verhagen AF, et al. Variation in incidence, prevention and treatment of persistent air leak after lung cancer surgery. Eur J Cardiothorac Surg, 2021, 61(1): 110-117.
4. 張瑛. 數字化胸腔閉式引流系統在心胸外科手術病人中的應用進展. 護理研究, 2022, 36(14): 2555-2558.Zhang Y. Application progress of digital drainage system in patients undergoing cardiothoracic surgery. Chin Nurs Res, 2022, 36(14): 2555-2558.
5. 中國醫師協會胸外科醫師分會, 海峽兩岸醫藥衛生交流協會胸外科專業委員會, 吳階平醫學基金會肺癌專業委員會, 等. 胸部手術圍術期持續性肺漏氣管理策略全國專家共識 (2023). 中華胸心血管外科雜志, 2024, 40(4): 193-200.Chinese Medical Doctor Association Thoracic Surgeon Branch, Wu Jieping Medical Foundation Lung Cancer Professional Committee, China Anti-Cancer Association Lung Cancer Integrated Rehabilitation Professional Committee, et al. Management strategies for persistent pulmonary air leak in the perioperative period of thoracic surgery: national expert consensus (2023). Chin J Thorac Cardiovasc Surg, 2024, 40(4): 193-200.
6. Attaar A, Luketich JD, Schuchert MJ, et al. Prolonged air leak after pulmonary resection increases risk of noncardiac complications, readmission, and delayed hospital discharge: a propensity score-adjusted analysis. Ann Surg, 2021, 273(1): 163-172.
7. Honda T, Tauchi S. Chest drainage outcomes by water seal versus low suction on digital thoracic drainage systems after lung resection: retrospective study. J Thorac Dis, 2024, 16(10): 6644-6650.
8. Cerfolio RJ. Chest tube management after pulmonary resection. Chest Surg Clin N Am, 2002, 12(3): 507-527.
9. 中華醫學會呼吸病學分會胸膜與縱隔疾病學組(籌). 胸腔積液診斷的中國專家共識. 中華結核和呼吸雜志, 2022, 45(11): 1080-1096.Pleural and Mediastinal Diseases Working Group (Preparatory) of Chinese Thoracic Society. Chinese expert consensus on diagnosis of pleural effusion. Chin J Tuberc Respir Dis, 2022, 45(11): 1080-1096.
10. Gioutsos K, Rieder O, Galanis M, et al. Risk factors for prolonged air leak after uniportal anatomical segmentectomy. Eur J Cardiothorac Surg, 2025, 67(3): ezaf030.
11. 賀高升, 何明, 朱輝. 數字胸腔引流系統在肺切除術中的應用價值. 中國腫瘤臨床, 2024, 51(2): 94-97.He GS, He M, Zhu H. The application value of digital thoracic drainage system in pneumonectomy. Chin J Clin Oncol, 2024, 51(2): 94-97.
12. Duron G, Backer E, Feller-Kopman D. Evaluation and management of persistent air leak. Expert Rev Respir Med, 2023, 17(10): 865-872.
13. Tsubokawa N, Mimae T, Ito R, et al. Effectiveness of pleurodesis for postoperative air leaks after lung resection. J Cardiothorac Surg, 2024, 19(1): 2.
14. Hong JI, Lee JH, Kim HK. Early pleurodesis for postoperative air leak with autologous blood and 50% glucose solution. J Chest Surg, 2023, 56(1): 16-22.
15. Taniguchi J, Aso S, Jo T, et al. Comparison between OK-432 and talc for pleurodesis in patients with persistent pulmonary air leak: a Japanese nationwide retrospective database study. Gen Thorac Cardiovasc Surg, 2025, 73(6): 428-435.
16. 樊榕榕, 李華艷, 陳思思, 等. 數字化胸腔引流系統在胸腔鏡肺切除術后應用的臨床價值. 中國微創外科雜志, 2021, 21(1): 13-17.Fan RR, Li HY, Chen SS, et al. Clinical value of digital drainage device in patients after thoracoscopic lung resection. Chin J Minim Invasive Surg, 2021, 21(1): 13-17.
17. 邊梅, 師文, 楊鑫. 便攜式數字智能胸腔引流系統的開發與研制. 中國醫療設備, 2023, 38(6): 43-49.Bian M, Shi W, Yang X. Development of portable digital intelligent thoracic drainage system. China Med Devices, 2023, 38(6): 43-49.
18. Palleiko BA, Singh A, Strader C, et al. Clinical outcomes and staff satisfaction after adoption of digital chest drainage system for minimally invasive lung resections. J Thorac Dis, 2024, 16(5): 2963-2974.
19. Comacchio GM, Marulli G, Mendogni P, et al. Comparison between electronic and traditional chest drainage systems: a multicenter randomized study. Ann Thorac Surg, 2023, 116(1): 104-109.
20. Qian J, Guo F, Chen M, et al. Risk factor analysis and predictive model development for air leakage after thoracoscopic pulmonary wedge resection. J Thorac Dis, 2024, 16(10): 6806-6819.
21. Lee JY, Lee J, Javakijkarnjanakul V, et al. Impact of postoperative prolonged air leakage on long-term pulmonary function after lobectomy for lung cancer. J Chest Surg, 2024, 57(6): 511-518.
22. 曹旭, 張新宇, 施月仙. 數字化胸腔引流系統對胸腔鏡肺部手術后應用效果的Meta分析. 護理實踐與研究, 2023, 20(4): 554-560.Cao X, Zhang XY, Shi YX. Meta-analysis of the application effect of digital thoracic drainage system after thoracoscopic pulmonary surgery. J Nurs Pract Res, 2023, 20(4): 554-560.
23. Ibrahim Farag GA, Abdelfadil Ibrahim M, Abd Alaziz Al Awady RS, et al. Efficacy of digital vs. traditional chest drainage systems in postoperative care following pulmonary resection: a meta-analysis. Chirurgia, 2025, 38(5): 331-338.
24. Chang PC, Chen KH, Jhou HJ, et al. Promising effects of digital chest tube drainage system for pulmonary resection: a systematic review and network meta-analysis. J Pers Med, 2022, 12(4): 512.
25. Thakur S, Kashyap NK, Saurabh G, et al. Evaluation of the efficacy of a digital chest drainage system in traumatic pneumothorax. Cureus, 2023, 15(6): e41188.
26. Barozzi L, Biagio LS, Meneguzzi M, et al. Novel, digital, chest drainage system in cardiac surgery. J Card Surg, 2020, 35(7): 1492-1497.
27. Geraci TC, Sorensen A, James L, et al. Use of a novel digital drainage system after pulmonary resection. J Thorac Dis, 2022, 14(9): 3145-3153.
28. Lee SA, Kim JS, Chee HK, et al. Clinical application of a digital thoracic drainage system for objectifying and quantifying air leak versus the traditional vacuum system: a retrospective observational study. J Thorac Dis, 2021, 13(2): 1020-1035.
29. Nakada T, Ohtsuka T. Thoracic drain management using a digital system. J Thorac Dis, 2023, 15(2): 219-222.

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Latest ArticlesApplication of digital thoracic drainage system in patients with air leak after pulmonary resection: A retrospective cohort study

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