Impact of hydrogel-coated chest drains on outcomes in thoracic surgery

OBJECTIVES To compare postoperative outcomes between hydrogel-coated chest drains (HCDs) and conventional non-coated drains (NCDs) in patients undergoing general thoracic surgery, using a propensity score-matched analysis. METHODS This retrospective multi-institutional study included adult patients who underwent thoracic surgery across four European centres between February and September 2022. Patients were grouped according to drain type (HCD vs NCD), and a propensity score-matched analysis was performed to account for 16 preoperative and intraoperative covariates. Primary outcome was length of postoperative hospital stay (LOS). Secondary outcomes included in-hospital complications, ICU admission, chest drain reinsertion, readmission, duration of drainage (LOD), and in-hospital mortality. Subgroup analysis was performed in patients undergoing anatomical lung resections. RESULTS A total of 773 patients were included (HCD n = 362; NCD n = 411). After matching, 724 patients were analysed. HCD use was associated with a significantly shorter LOS (ATT -1.87 days; 95% CI -3.04 to -0.695; p = 0.002), lower odds of ICU admission (OR 0.29; 95% CI 0.16–0.53; p < 0.001), and lower in-hospital complication rates (OR 0.38; 95% CI 0.26–0.55; p < 0.001). Rates of pneumonia (5.2% vs 13.4%; p = 0.001), atrial fibrillation (2.2% vs 9.0%; p < 0.001), and retained pleural effusion (0.8% vs 3.6%; p = 0.015) were significantly lower in the HCD group. There were no significant differences in drain duration, readmission, or mortality. In the anatomical resection subgroup, HCDs were similarly associated with reduced LOS and complications. CONCLUSIONS Hydrogel-coated drains are associated with fewer postoperative complications and shorter hospital stay compared to conventional drains, particularly in anatomical lung resections. These findings support further prospective evaluation to define the role of HCDs in routine thoracic surgical practice.