A service evaluation to explore whether the use of digital chest drains reduced chest drain duration following thoracic surgery

Purpose

Chest drains are required following thoracic surgery however prolonged drain duration can limit postoperative mobility and increase hospital length of stay (LOS). The use of digital portable chest drains with inbuilt suction and more accurate measurement of drainage/air leak has been an innovation in rehabilitation following thoracic surgery allowing individuals to mobilise with drains still in and on suction. This potentially enables earlier postoperative mobilisation, reduced drain duration and reduced hospital LOS.

Digital drains were introduced in February 2017 for use with individuals following thoracic surgery performed by one thoracic surgeon. Other surgeons continued to use under water seal (UWS) drains.

The primary aim was to explore whether the use of digital chest drains reduced drain duration compared to UWS drains following thoracic surgery. Secondary aims were to explore whether the use of digital drains reduced hospital LOS, time on physiotherapy caseload or allowed earlier postoperative mobilisation.

Approach

Data collection was for 6 months between February 2017 and July 2017 for all individuals following thoracic surgery referred to physiotherapy. Data was collected retrospectively from physiotherapy ward sheets, chest radiographs and an electronic patient record system. Data was analysed using descriptive statistics (median, upper and lower quartiles) and statistical tests (The Mann Whitney U Test).

Outcomes

There was no statistically significant difference in chest drain duration between the digital drain group and the UWS group (median difference 0, 95% CI 0-0 P= 0.91).

Median hospital LOS was shorter for the digital drain group compared to the UWS group however this difference was not statistically significant (median difference 1, 95% CI 0-1 P= 0.06).

Time on physiotherapy caseload was statistically significantly shorter for the digital drain group compared to the UWS drain group (Median difference 1, 95% CI 1-2 P= 0.02).

Median day first mobilised postoperatively was statistically significantly shorter for the digital drain group compared to the UWS drain group (Median difference 1, 95% CI 1-2 P=0.0001).

Implications

The use of digital chest drains did not significantly reduce chest drain duration following thoracic surgery. Median hospital LOS was shorter for the digital drain group although this difference was not statistically significant. The use of digital drains significantly reduced time on physiotherapy caseload and day first mobilised postoperatively.

Analysis of 12 month data should be undertaken to explore the longer term impact of digital drains with a larger sample size. Limitations included the short duration of the service evaluation featuring the introductory period of the digital drains and the relatively small sample size. Data was retrospectively collected from physiotherapy ward sheets rather than prospectively from medical notes. There was incomplete data on chest drain duration for eight individuals discharged from hospital with a chest drain.

The use of digital chest drains following thoracic surgery did not significantly reduce chest drain duration or hospital LOS in this six month service evaluation following the introduction of digital chest drains.

The use of digital drains allowed significantly earlier postoperative mobilisation and discharge from physiotherapy caseload.

Analysis of 12 month data should be considered once available.

Funding acknowledgements

This work is unfunded.

Additional notes

This work was presented at Physiotherapy UK 2019