Postoperative drainage with double 8F ultrafine chest tubes improves pain control and reduces specific complications in uniportal thoracoscopic lung tumor resection: a retrospective multicenter cohort study.

BACKGROUND

Uniportal video-assisted thoracoscopic surgery (U-VATS) is a well-established minimally invasive approach for lung tumors, but consensus on the optimal size and number of postoperative chest tubes remains lacking. Ultrafine pigtail chest tubes may reduce tissue injury and improve wound healing compared with traditional drainage methods, yet evidence supporting their safety and feasibility in U-VATS patients is insufficient.

METHODS

This retrospective multicenter cohort study enrolled 1,076 lung tumor patients who underwent U-VATS across three Chinese hospitals. Patients were assigned to three groups: double 8F ultrafine chest tube (n = 427), 22F + 8F chest tube (n = 452), and single 24F chest tube (n = 197). Perioperative outcomes were analyzed using 1:1:1 propensity score matching (PSM) and linear regression models to adjust for confounders.

RESULTS

Multivariate analysis identified chest tube characteristics, pleural adhesions, postoperative infection, air leakage, intrathoracic hemorrhage, drainage volume as independent factors associated with drainage duration. After PSM (93 cases/group), the double 8F group had significantly lower NRS pain scores [postoperative days (POD) 1-3], reduced early drainage volume (POD1 and POD3), and lower incidences of atelectasis and intrathoracic hemorrhage (all p < 0.05) compared with the 22F + 8F group. It showed comparable hospital stay and total drainage volume to the other two groups. The single 24F group had the shortest drainage duration (p < 0.001), with no intergroup differences in infection, air leakage, reintubation, or chylothorax.

CONCLUSION

Double 8F ultrafine chest tubes do not shorten drainage duration but effectively alleviate postoperative pain (especially on POD1), reduce early postoperative drainage volume, and lower specific complications. Aligning with enhanced recovery after surgery (ERAS) principles, they represent a promising drainage strategy for lung tumor patients after U-VATS.