# Impact of Hydrogel-Coated Chest Drains on Outcomes in Thoracic Surgery

## TL;DR

Hydrogel-coated chest drains reduce hospital stays and complications after thoracic surgery compared to conventional drains.

## Contribution

Demonstrates that hydrogel-coated drains improve postoperative outcomes in thoracic surgery through a multi-center propensity score-matched analysis.

## Key findings

- Hydrogel-coated drains were associated with a 1.87-day shorter hospital stay compared to conventional drains.
- Use of hydrogel-coated drains reduced ICU admission odds and in-hospital complication rates significantly.
- Fewer cases of pneumonia, atrial fibrillation, and retained pleural effusion were observed with hydrogel-coated drains.

## Abstract

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.

This retrospective multi-institutional study included adult patients who underwent thoracic surgery across 4 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. The primary outcome was length of postoperative hospital stay (LOS). Secondary outcomes included in-hospital complications, intensive care unit (ICU) admission, chest drain reinsertion, readmission, duration of drainage, and in-hospital mortality. Subgroup analysis was performed in patients undergoing anatomical lung resections.

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 (average treatment effect of the treated population −1.87 days; 95% CI −3.04 to −0.695; P = .002), lower odds of ICU admission (odds ratio [OR] 0.29; 95% CI 0.16-0.53; P < .001), and lower in-hospital complication rates (OR 0.38; 95% CI 0.26-0.55; P < .001). Rates of pneumonia (5.2% vs 13.4%; P = .001), atrial fibrillation (2.2% vs 9.0%; P < .001), and retained pleural effusion (0.8% vs 3.6%; P = .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.

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.

Chest drains are an essential component of postoperative care following thoracic surgery, facilitating evacuation of air and fluid from the pleural space to restore lung function and reduce the risk of complications such as infection, atelectasis, and pleural adhesions.