This prospective European Society of Thoracic Surgeons (ESTS) Drainology Collaborative registry study examined chest-drain practice after pulmonary resection in 3,348 patients across 21 international centers, 88 percent of whom underwent minimally invasive surgery. Prolonged air leak (PAL) occurred in 9.0 percent, pulmonary complications in 7 percent, and in-hospital mortality in 0.9 percent. Larger-bore drains were independently associated with lower odds of PAL, whereas digital drainage systems identified more PALs but were associated with shorter hospital stays.
Marked, non-random variation existed between centers regarding drain size, digital-drain adoption, and PAL rates. For CTSNet’s global thoracic surgery audience, this study exposes substantial variation in a routine but consequential element of postoperative care. These real-world data support more evidence-based, standardized chest-drain protocols within enhanced-recovery pathways, while identifying drain size and digital monitoring as priority targets for future pragmatic trials.
