Chest drainage outcomes by water seal versus low suction on digital drainage systems after lung resection: retrospective study

Background: Despite advances in chest drainage technology, such as the use of digital drainage systems (DDS), there is still no consensus on the most effective method for reducing air leaks after lung resection. To evaluate the optimal drainage method, we compared traditional water seal with low suction pressure settings on DDS. Methods: We retrospectively analyzed the postoperative data of patients between August 2015 and April 2023 who underwent anatomical lung resection at our hospital and who had postoperative chest drains managed with either a water seal or DDS set to low suction pressure. We excluded cases without air leak on the first postoperative morning from the consideration in this study. We divided the patients into two groups according to the chest drainage method on the first postoperative morning and we compared air leak and chest drainage durations of both groups. Results: We retrospectively analyzed 116 patients. The groups (water seal: 59 patients; low suction: 57 patients) were well balanced for baseline and degree of air leakage on the first operative morning. The water seal group showed significantly shorter air leak duration (2 vs. 3 days, P<0.001) and chest drainage duration (3 vs. 5 days, P<0.001) compared with the low suction group. Pleurodesis (P=0.002) and conversion (P=0.001) were higher in the low suction group, with no significant differences in drain reinsertion. Conclusions: Water seal management was suggested to be safe and comparably effective to low suction on DDS in reducing air leak and chest drainage durations after lung resection.