Multimodal digital assessment of early recovery after chest tube omission in early-stage lung cancer patients undergoing wedge resection: a post hoc analysis of a prospective cohort.

Abstract

Background: Given the limited surgical trauma associated with wedge resection, the clinical impact of routine chest tube drainage may be more apparent in early postoperative recovery than in safety outcomes alone. We used a multimodal digital platform integrating wearable monitoring and electronic patient-reported outcomes (ePROs) to compare recovery after wedge resection with and without chest tube placement.

Methods: This study was a post hoc secondary analysis of prospectively collected data from a registered single-center observational cohort (NCT06118229). We included 98 patients from the parent cohort who had M0 primary lung cancer, underwent wedge resection, and had evaluable perioperative clinical and digital data; 54 were managed without chest tube placement and 44 with routine drainage. Propensity score matching yielded 34 matched pairs.

Results: Compared with the chest tube group, the no chest tube group had a shorter postoperative hospital stay (2.51±1.11 vs. 3.14±1.03 days; P=0.02). Differences were most apparent in patient-reported recovery on postoperative day 2, with lower pain scores (2.79±2.11 vs. 4.08±2.07; P=0.03), less restless sleep (1.98±1.86 vs. 3.49±2.32; P=0.01), and less drowsiness (2.07±1.35 vs. 3.08±1.70; P=0.02). Wearable-derived physiologic trajectories were largely similar, although oxygen saturation on postoperative day 1 was higher in the no chest tube group (97.22%±1.64% vs. 96.05%±1.56%; P=0.003).

Conclusions: After wedge resection, omission of routine chest tube drainage was associated with a more favorable early patient-reported recovery, whereas physiologic differences were modest. Multimodal digital assessment may offer a practical and patient-centered approach to postoperative monitoring after minimally invasive thoracic surgery.