Digital chest drain in paediatric surgical patients

Abstract Purpose Chest drains used after thoracoscopic and open surgery traditionally rely on underwater drain (UWD). While Thopaz+ digital chest drain is NICE-recommended for adults, its usage in paediatric populations is underreported. This quality improvement project (QIP) evaluated the efficacy and safety of adopting Thopaz + in paediatric surgical patients. Methods Thopaz + was introduced in the Paediatric surgery department. Retrospective data were collected for patients undergoing thoracic operations between 10/2022 and 07/2025, including demographics, chest drain indication, drain duration, and complications. Results Of forty-nine patients (aged 1 day to 17 years; median age: 2.34 years, IQR 0.29–13.19), 55.10% ( N = 27) used Thopaz + and 44.90% ( N = 22) used UWD. Thopaz+ group was significantly older (median 12.2 years-old (2.3, 15.1), 95% CI: 6.7–12.0) and heavier (median 44 kg (16,55), 95% CI: 29–47) than UWD group (median 0.3years-old (0.0, 1.9), 95% CI: 0.73–5.6; median 12 kg (9,16), 95% CI: 11–26), reflecting absence of Thopaz+ adoption for neonates within the trust ( p < 0.001 for age; p = 0.002 for weight). Thopaz+ trended towards a shorter chest drainage duration, with a median of 2 days (1.0, 6.0; 95% CI 2.1–5.9), vs. median of 3.5 days (2.0, 7.0; 95% CI 1.2–16) with UWD, although not statistically different ( p = 0.088). Complication rate was not significantly different: 22.2% ( N = 6/27; 95% CI 9.4–43) with Thopaz + vs. 9.1% ( N = 2/22; 95% CI 1.6–31) with UWD. Satisfaction survey heavily favoured Thopaz+. Conclusion This study shows Thopaz + can be safely and feasibly implemented in paediatric surgical practice. Larger, multicentre studies are needed to define the cost-effectiveness and develop paediatric clinical protocol.