Journal of Thoracic Disease

• Omitting chest drains (NCD) significantly reduced length of stay (LOS) compared to conventional chest drain placement (CD). — 1.53 days shorter LOS (WMD -1.53, P<0.001) (Patients undergoing VATS procedures)
• NCD group experienced lower postoperative pain scores on POD 1. — WMD -1.09 (P=0.002) (Patients undergoing VATS procedures)
• NCD group had a higher risk of requiring subsequent drain insertion or thoracocentesis. — RR 3.02 (P=0.040) (Patients undergoing VATS procedures)
• No significant difference in incidence of minor pneumothorax, pleural effusion, subcutaneous emphysema, or pneumonia. — Pneumothorax RR 1.77 (P=0.128); Pleural effusion RR 1.88 (P=0.219); Subcutaneous emphysema RR 1.37 (P=0.427); Pneumonia RR 0.53 (P=0.549) (Patients undergoing VATS procedures)
• No mortality observed in either group. — 0% mortality (In-hospital or 30-day observation period)

Setup

1,079 patients total (561 NCD, 518 CD) across 10 studies; procedures included lung wedge resection, lung biopsy, and mediastinal tumour resection.

How

Systematic review and meta-analysis of 10 studies (4 RCTs, 6 non-RCTs) comparing intraoperative removal of chest drains after an air leakage test (NCD) versus conventional placement (CD). Data were extracted from MEDLINE, EMBASE, Web of Science, and Cochrane Library.

Limitations

Small number of high-quality studies (70% high risk of bias) · Potential selection and reporting bias in non-RCTs · Lack of data on major surgeries like lobectomy and segmentectomy · Potential statistical bias from converting interquartile ranges to mean/SD

Summarized by Gemma 4 from the open-access full text · 2 Oct 2026. Read it