Post-surgical outpatient chest drain management using digital devices and a social media application-based protocol

Persistent air leak and prolonged pleural drainage are common causes of delayed discharge following thoracic surgery, leading to increased hospital stay. This increases healthcare costs, blocks bed availability, and increases the risk of hospital-acquired infections. Outpatient chest drain management (OPCDM) has been used as a strategy to reduce length of stay, but its use has traditionally been limited to selected patients with low air leaks and stable lung expansion.

To assess the feasibility and safety (defined as successful outpatient completion without readmission or major intervention) of a structured OPCDM protocol using digital drainage devices and remote monitoring, and to describe the incidence of complications and to estimate the institutional economic impact of the protocol.

This retrospective, single-center study included 167 consecutive patients discharged with an intercostal drain (88% with digital devices on suction) between January 2024 and October 2025, based on predefined clinical criteria. Patients were monitored using a standardized protocol involving daily WhatsApp-based image transmission of device data and scheduled outpatient follow-up. Outcomes assessed included treatment success, complications, readmissions, and the relationship of air leak magnitude with the duration of outpatient management. An exploratory institutional cost analysis was done.

Outpatient management was successful in 157 patients (94%). Complications occurred in ten patients (6%), of whom five required readmission and five were managed as outpatients. Pleural infections occurred in three patients (1.9%), two of whom required additional surgery (1.2%). Most patients required one to two follow-up visits (7-14 days). A total of 17/87 (19.5%) patients with air leaks required outpatient care beyond 14 days (10.2% of the entire cohort). A clear relationship was observed between the magnitude of air leaks and the duration of outpatient management. No formal health economic evaluation was performed. An exploratory institutional cost-based analysis suggested potential savings and reduced inpatient bed utilization.

OPCDM using digital drainage devices and remote monitoring was feasible in selected patients, including those with moderate-to-high air leaks. It was associated with low complication and readmission rates. The combination of digital drainage and telemonitoring may have the potential to support an extension of OPCDM eligibility to selected patients previously considered unsuitable. Our limited institutional cost analysis suggests that OPCDM has the potential to reduce hospital stay, improve inpatient bed utilization, and reduce costs. Since our economic analysis was exploratory and institution-specific and a formal health economic evaluation was not performed, a definitive conclusion is not possible. Prospective multicenter studies are needed to confirm these findings and refine selection criteria for OPCDM.