Suction Impact on Chest Drain Duration After Lung Resection: A Study Using Digital Drainage Systems

Background/Objectives: The aim of this study was to evaluate whether no suction management to chest drains after pulmonary resection shortens the duration of chest tube placement and improves postoperative outcomes compared to routine application of negative-pressure suction to chest drains. Methods: A single-center randomized controlled study was conducted in patients undergoing lung resection. Patients received a single 28Fr chest tube attached to a digital drainage system. Patients were randomized to Control (chest tube on continuous suction) or No Suction. Results: From December 2022 to April 2025, 309 patients were enrolled; 23 patients were excluded for protocol deviations. In total, 286 patients were analyzed (149 Control, 137 No Suction). Chest tube duration was shorter in the No Suction (mean 40.2 ± 43.8 h) than the Control group (53.6 ± 67.8 h, p = 0.002). Hospital length of stay and the incidence of prolonged air leak did not differ between No Suction and Control. In multivariable regression, suction was associated with a 13 h longer time to drain removal (95% confidence interval 0.03 to 27 h; p = 0.050), without a significant effect on length of stay or odds of prolonged air leak. Patients with underlying lung disease or undergoing anatomical resection had overall longer chest tube durations. Conclusions: Application of suction to chest tubes after lung resection prolongs the duration of chest drainage without improving clinical outcomes. Managing chest tubes with physiologic intrapleural pressure and no suction may allow for earlier removal of drains and should be considered as the approach in uncomplicated lung resections.