Might digital drains speed up the time to thoracic drain removal?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: might digital drains speed up the time to thoracic drain removal in terms of time till chest drain removal, hospital stay and overall cost? A total of 296 papers were identified as a result of the search as described below. Of these, five papers provided the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. A literature search revealed that several single-centre prospective randomized studies have shown significantly earlier removal of chest drains with digital drains ranging between 0.8 and 2.1 days sooner. However, there was heterogeneity in studies in the management protocol of chest drains in terms of the use of suction, number of drains and assessment for drain removal. Some protocols such as routinely keeping drains irrespective of the presence of air leak or drain output may have skewed results. Differences in exclusion criteria and protocols for discharging home with portable devices may have biased results. Due to heterogeneity in the management protocol of chest drains, there is conflicting evidence regarding hospital stay. The limited data on cost suggest that there may be significantly lower postoperative costs in the digital drain group. All the studies were single-centre series generally including patients with good preoperative lung function tests. Further larger studies with more robust chest drain management protocols are required especially to assess length of hospital stay, cost and whether the results are applicable to a larger patient population.
Department of Cardiothoracic Surgery, St George's Hospital, London, UK.
Jonathan
J
Afoke
Department of Cardiothoracic Surgery, St George's Hospital, London, UK.
Carol
C
Tan
Department of Cardiothoracic Surgery, St George's Hospital, London, UK.
Ian
I
Hunt
Department of Cardiothoracic Surgery, St George's Hospital, London, UK mustafa.zakkar@nhs.net.
Mustafa
M
Zakkar
D019985:Benchmarking; D020878:Device Removal / Q000191:economics; D004322:Drainage / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D004867:Equipment Design; D019317:Evidence-Based Medicine; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D011013:Pneumonectomy / Q000009:adverse effects* / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome
Cost; Digital drains; Hospital stay; Lung resection