[Safety and Clinical Benefit Analysis of No-chest-tube Strategy After Uniportal Video-assisted Thoracoscopic...

With the wide application of uniportal video-assisted thoracoscopy in the diagnosis and treatment of small pulmonary nodules, the optimization of postoperative chest tube management has become a focus of enhanced recovery after thoracic surgery. This study aimed to investigate the safety and non-inferiority of a no-drain strategy following uniportal video-assisted thoracoscopic wedge resection.

A total of 203 eligible patients who underwent surgery between January 2023 and May 2025 were enrolled and allocated to the no-drain group (n=53) and the drain group (n=150). After propensity score matching (PSM), 41 well-balanced pairs were generated. Non-inferiority testing combined with Bayesian analysis was performed to assess postoperative outcomes.

After PSM, the no-drain group met the predefined non-inferiority criteria for the incidence of postoperative fever (19.51% vs 26.83%), pleural effusion (24.39% vs 21.95%), and the proportion of patients requiring additional analgesics (12.20% vs 9.76%), with the upper bound of the 95%CI for between-group differences not exceeding the 10% non-inferiority margin. The no-drain group demonstrated a significantly shorter median postoperative length of stay (2.00 vs 3.00 d, P<0.001) and lower visual analogue scale (VAS) scores on postoperative day 1 (P=0.0495), with non-inferiority confirmed. However, non-inferiority was not established for secondary intervention rates (primarily chest tube reinsertion, 4.88% vs 0.00%) or radiologic complications (73.17% vs 65.85%), as the upper limit of the 95%CI for the between-group differences exceeded the 10% margin. Bayesian analysis showed that the probability that the positive rate of imaging-related complications in the no-drain group was higher than that in the drain group was 77.18%, and the probability that the absolute value of the difference in positive rates between the two groups greater than 10.0% was 44.45%.

In carefully selected low-risk patients, a no-drain strategy following uniportal thoracoscopic wedge resection may reduce postoperative pain and shorten hospital stay, while meeting non-inferiority criteria for key safety outcomes. However, non-inferiority was not demonstrated for secondary chest tube insertion or radiologic complications. Enhanced postoperative monitoring is therefore essential to ensure clinical safety.