title: Electronic versus traditional chest tube drainage following lobectomy: a randomized trial.
abstract: OBJECTIVE
  Electronic drainage systems have shown superiority compared with traditional (water seal) drainage systems following lung resections, but the number of studies is limited. As part of a medico-technical evaluation, before change of practice to electronic drainage systems for routine thoracic surgery, we conducted a randomized controlled trial (RCT) investigating chest tube duration and length of hospitalization.
  
  
  METHODS
  Patients undergoing lobectomy were included in a prospective open label RCT. A strict algorithm was designed for early chest tube removal, and this decision was delegated to staff nurses. Data were analysed by Cox proportional hazard regression model adjusting for lung function, gender, age, BMI, video-assisted thoracic surgery (VATS) or open surgery and presence of incomplete fissure or pleural adhesions. Time was distinguished as possible (optimal) and actual time for chest tube removal, as well as length of hospitalization.
  
  
  RESULTS
  A total of 105 patients were randomized. We found no significant difference between the electronic group and traditional group in optimal chest tube duration (HR = 0.83; 95% CI: 0.55-1.25; P = 0.367), actual chest tube duration (HR = 0.84; 95% CI: 0.55-1.26; P = 0.397) or length of hospital stay (HR = 0.91; 95% CI: 0.59-1.39; P = 0.651). No chest tubes had to be reinserted. Presence of pleural adhesions or an incomplete fissure was a significant predictor of chest tube duration (HR = 1.72; 95% CI: 1.15-2.77; P = 0.014).
  
  
  CONCLUSIONS
  Electronic drainage systems did not reduce chest tube duration or length of hospitalization significantly compared with traditional water seal drainage when a strict algorithm for chest tube removal was used. This algorithm allowed delegation of chest tube removal to staff nurses, and in some patients chest tubes could be removed safely on the day of surgery.
authors.affiliation: Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark elle.lijkendijk@rsyd.dk.
authors.forename: Marike
authors.initials: M
authors.lastname: Lijkendijk
authors.affiliation: Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Licht
authors.affiliation: Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Neckelmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015505:Chest Tubes; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D013396:Suction / Q000295:instrumentation / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
keywords: Air leak; Chest tube; Electronic pleural drainage system; Fast-track surgery; Postoperative management; Pulmonary lobectomy