Multimodal digital assessment of early recovery after chest tube omission in early-stage lung cancer patients undergoing wedge resection: a post hoc analysis of a prospective cohort

Introduction

Sublobar resection, including wedge resection, has increasingly been adopted for carefully selected patients with small peripheral non-small cell lung cancer (NSCLC). Prospective multicenter studies have demonstrated favorable perioperative and oncologic outcomes after sublobar resection, particularly for small, node-negative tumors and radiologically low-invasive, ground-glass opacity-dominant lesions amenable to adequate-margin resection (1-4). However, whether routine postoperative chest tube drainage provides meaningful benefits for early recovery in this low-trauma setting remains uncertain (5,6). The controversy extends beyond procedural safety to include recovery burden and patient experience (7-9). Conventional perioperative endpoints, such as postoperative hospital stay, drainage-related outcomes, and postoperative complications may provide only a partial view of early recovery (8,10,11). This limitation may be particularly relevant after wedge resection, in which between group differences are likely to be subtle and closely related to recovery quality. At the same time, increasing emphasis on patient centered care has shifted attention beyond technical success toward symptom control, functional recovery, and patients’ subjective experiences (8,12,13).

To address this question, recovery should be assessed longitudinally rather than only through isolated bedside observations. In this context, continuous and patient centered perioperative monitoring has become increasingly important for evaluating surgical strategies. Wearable devices allow continuous assessment of physiologic and behavioral parameters, including oxygen saturation, heart rate, temperature, sleep, and activity, and may therefore detect recovery signals that are easily missed by intermittent assessment (14,15). Perioperative studies in lung cancer have already suggested that wearable monitoring can help track physical recovery and link longitudinal physiologic data to functional outcomes (16).

Objective monitoring and patient-reported assessment should therefore be interpreted together rather than separately, because objective physiologic monitoring alone cannot fully capture symptom burden. Electronic patient-reported outcomes (ePROs) provide direct and repeated assessments of symptoms and functional impairment from the patient perspective (13). Randomized studies in lung cancer surgery have shown that ePRO-based symptom management can reduce postoperative symptom burden and improve functional recovery during both short-term and longer-term follow-up (17-19). Thus, wearable data and ePROs address complementary gaps: the former provides continuous objective context, whereas the latter captures subjective recovery experience. Together, these modalities may provide a more complete and patient-centered profile of perioperative recovery than conventional endpoints alone. The feasibility of this approach in thoracic surgery has also been supported by recent studies integrating wearable monitoring with ePROs and extending ePRO-based symptom surveillance from hospitalization into the post-discharge period (14,20).

In this study, we used a multimodal digital platform that integrated wearable monitoring and ePROs to characterize perioperative recovery after wedge resection with or without chest tube drainage. We compared conventional perioperative outcomes, patient-reported recovery, and physiologic trajectories recorded by wearable devices between groups. We hypothesized that omission of chest tube drainage would be associated with a more favorable early recovery profile, particularly in patient reported domains, while wearable based measures would provide continuous physiologic context for interpreting these findings. We present this article in accordance with the STROBE reporting checklist (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2026-0758/rc).

Methods

Ethics approval, parent cohort and current study design

The parent study was a single-center prospective observational cohort approved by the Ethics Committee of The First Affiliated Hospital of Guangzhou Medical University (ES-2024-073-02) and registered at ClinicalTrials.gov (NCT06118229). The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The parent cohort was designed to evaluate the role of wearable devices and ePROs in patients undergoing pulmonary resection with postoperative pathological confirmation of primary lung cancer (14). All participants provided written and verbal informed consent before enrollment. The present study was a post hoc secondary analysis of prospectively collected data from this registered parent cohort.

For the present analysis, we included adult patients aged ≥18 years with an American Society of Anesthesiologists (ASA) grade of III or lower who were enrolled between March and December 2023, had M0 primary lung cancer, underwent wedge resection via video-assisted thoracoscopic surgery (VATS), and had evaluable perioperative clinical and digital data. The exclusion criteria were as follows: (I) inability to use a wearable device or poor compliance with device use; (II) no access to a smartphone; (III) incomplete evaluable digital data during hospitalization; and (IV) confirmed distant metastasis.

Chest tube management was not assigned by the parent cohort protocol. The decision to omit or place a postoperative chest tube was made intraoperatively as part of routine clinical care according to predefined clinical criteria and the operating surgeon’s judgment; chest tube status was therefore treated as an observational exposure in the present analysis. Patients were followed from preoperative day 1 through postoperative day 15 using clinical records, wearable monitoring, ePRO assessments, and postoperative surveillance.

No formal sample-size calculation was performed because this exploratory analysis used a fixed prospectively enrolled parent cohort. The analytic sample was determined by the number of participants in the parent cohort who met the eligibility criteria for the current analysis during the study period.

The extent of pulmonary resection was determined as part of routine clinical care. Limited resection was generally considered for small, peripheral lesions with radiologically low-invasive features and, when clinically appropriate, for patients with multiple pulmonary lesions or limited physiologic reserve. All patients underwent intraoperative frozen-section examination, and the findings were used, together with margin assessment and the overall clinical context, to determine whether a more extensive pulmonary resection and lymph node sampling or dissection were required. For the current analysis, we selected from the parent cohort those patients for whom wedge resection remained the definitive surgical procedure. All included patients had postoperative pathological confirmation of primary lung cancer; patients with benign lesions or pulmonary metastases were not included.

Criteria for chest tube omission, postoperative surveillance and discharge

All procedures were performed by 3 senior thoracic surgeons, each with at least 15 years of operative experience and proficiency in both open and video-assisted thoracic surgery. Intraoperative air leakage was assessed in two steps before thoracic closure. First, the staple line and adjacent lung parenchyma were immersed in warm saline, and the operated lung was re-expanded under controlled positive-pressure ventilation while the resection surface was inspected thoracoscopically for visible bubbling. Second, a temporary tube was connected to a water-seal system during lung re-expansion, and the absence of continuous bubbling was considered to indicate no persistent air leak. After the final assessment confirmed the absence of a persistent air leak, chest tube omission was considered in selected patients undergoing wedge resection for small peripheral lung lesions, provided that the resection was uncomplicated, the lung was fully re-expanded, and no active bleeding, concerning pleural oozing, severe pleural adhesions, or other intraoperative conditions warranted postoperative drainage. Routine chest tube drainage was used when the operating surgeon considered postoperative drainage necessary because of suspected or observed air leak, pleural adhesion, a larger or more complex resection surface, concern regarding complete lung re-expansion, potential bleeding risk, or other patient- or procedure-related safety considerations. In patients receiving postoperative drainage, chest tube removal was based on predefined clinical and radiographic criteria rather than on a fixed postoperative day. Removal was considered when chest radiography demonstrated satisfactory lung re-expansion without a clinically significant residual pleural space or progressive pneumothorax; no air leak was observed in the water-seal chamber during coughing; the drainage was serous, non-bloody, non-chylous, and non-purulent, with no evidence of active bleeding; the drainage volume was ≤200 mL during the preceding 24 hours; and the patient had no significant dyspnea, oxygen desaturation, or other clinical condition requiring continued pleural drainage (21,22).

Postoperatively, vital signs, including respiratory rate, heart rate, blood pressure, and oxygen saturation, were closely monitored. All patients underwent chest radiography and thoracic ultrasonography within 12 hours after surgery; imaging was repeated at approximately 48 hours in patients who remained hospitalized, with additional assessments performed as clinically indicated. Discharge required hemodynamic and respiratory stability, satisfactory lung re-expansion without progressive pneumothorax, clinically significant pleural effusion, or active bleeding, adequate pain control with oral analgesics, tolerance of oral intake, and independent or minimally assisted ambulation. In patients receiving postoperative drainage, chest tube removal was required before discharge. Postoperative hospital stay was defined as the interval from the date of surgery to the date of hospital discharge.

Wearable device and data collection

The HUAWEI WATCH D (Huawei Device Co., Ltd, Shenzhen, China), a wrist worn Class II medical device approved by the National Medical Products Administration of China, was used in this study. The device incorporates an oscillometric blood pressure system based on a micromechanical pump together with multimodal sensors for physiologic monitoring (23,24). Previous studies have demonstrated acceptable measurement accuracy and feasibility for this wearable platform (14,25). In the present study, body temperature, heart rate, oxygen saturation, sleep quality score, and step count were collected continuously.

Electronic patient-reported outcomes data collection

ePROs were collected using a self-developed platform that supported direct patient entry, embedded logic checks, and real time validation. The questionnaire assessed nine symptoms: pain, cough, shortness of breath, restless sleep, fatigue, drowsiness, difficulty walking, activity limitation, and distress. Each symptom was rated on a 0 to 10 scale, where 0 indicated no symptom and 10 indicated the most severe symptom. Patients completed the survey once daily at 7:00 PM during hospitalization. If a questionnaire remained incomplete, automated reminders were sent every 30 minutes until 10:00 PM, and investigators followed up when necessary. Research staff monitored survey completion and reviewed submitted data daily, including anomaly checks and patient confirmation when needed.

Clinical data collection

Clinical data included baseline variables [age, sex, and body mass index (BMI)], tumor characteristics [pathologic type, location, size, and clinical tumor-node-metastasis (cTNM) stage], and operative factors (ASA grade, operative time, anesthesia time, anesthesia method, lymph node dissection, and intraoperative blood loss). Operative time was defined as the interval from skin incision to wound closure, and anesthesia time as the interval from the anesthesiologist’s first intervention to transfer to the postanesthesia care unit or intensive care unit. Perioperative outcomes included postoperative hospital stay, chest tube drainage volume, and chest tube duration. Perioperative assessments were performed at 5 predefined time points: preoperative day 1, surgery day, postoperative day 1, postoperative day 2, and postoperative day 15.

Statistical analysis

Continuous variables were summarized as means ± standard deviations (SDs) or medians (range), and categorical variables as counts (percentages). To reduce selection bias and confounding by indication, predefined criteria for chest tube omission were applied and propensity score methods were used for baseline balancing. Propensity score matching was performed using 1:1 nearest neighbor matching without replacement and with a caliper of 0.1 to balance age, sex, BMI, cT stage and ASA grade between groups. Missing wearable and ePRO data were handled using multiple imputation by chained equations, with 20 imputations over 20 iterations. The imputation model included chest tube status, baseline covariates, perioperative variables, and adjacent time point measurements from the same outcome domain, whereas structurally inapplicable variables were excluded. The number of participants with missing data for each variable is summarized in Table S1. Outcomes in the matched cohort were analyzed using linear models accounting for matched pair and were pooled using Rubin’s rules. To assess the robustness of the postoperative day 2 ePRO findings, a complete-case sensitivity analysis was performed using the same linear model accounting for matched pairs, without imputation. For each outcome, this analysis was restricted to matched pairs in which both patients had observed postoperative day 2 data. Categorical variables were compared using the chi square test or Fisher exact test, as appropriate. All tests were two sided, and P<0.05 was considered statistically significant. The overall study workflow is shown in Figure 1.

Figure 1 Overall study workflow. Schematic of patient selection, propensity score matching, multimodal perioperative data collection, and downstream analyses. Clinical data, ePROs, and wearable-derived physiologic and behavioral measures were collected across predefined perioperative time points. ASA, American Society of Anesthesiologists; BMI, body mass index; cT stage; clinical tumor stage; ePROs, electronic patient-reported outcomes; IBL, intraoperative blood loss; POS, postoperative hospital stay; PSM, propensity score matching; SH, surgical hours.

Results

Participant characteristics and baseline data

As shown in Figure 2, the source dataset for the present secondary analysis comprised 263 participants from the registered parent prospective observational cohort. Among them, 98 patients had M0 primary lung cancer, underwent wedge resection, and had evaluable perioperative clinical and digital data, thereby meeting the eligibility criteria for the current analysis. These patients included 54 in the no chest tube group and 44 in the chest tube group. After 1:1 propensity score matching, 34 matched pairs were included in the outcome analyses. Before matching, the two groups differed in BMI (22.02±2.92 vs. 23.35±3.09 kg/m²; P=0.03) and cT stage distribution (P=0.04). After matching, baseline characteristics were well balanced, with no significant between group differences in age, BMI, sex, cT stage, or ASA grade (all P>0.05; Table 1). All matched patients underwent wedge resection.

Figure 2 Flowchart of patient selection and propensity score matching. Of 263 enrolled patients, 98 M0 patients undergoing wedge resection were eligible, including 54 without chest tube placement and 44 with routine drainage. Propensity score matching yielded 34 matched pairs for final analysis. ASA, American Society of Anesthesiologists; BMI, body mass index; cT stage; clinical tumor stage.

Comparison of perioperative outcomes

Perioperative outcomes are summarized in Table 2. Operative time, anesthesia time, and intraoperative blood loss were comparable between groups (all P>0.05). However, the no chest tube group had fewer dissected N1 lymph nodes (0.09±0.38 vs. 0.47±0.51, P<0.001) and N2 lymph nodes (0.26±0.71 vs. 1.03±1.31, P=0.004). The postoperative hospital stay was shorter in the no chest tube group than in the chest tube group (2.51±1.11 vs. 3.14±1.03 days, P=0.02). Among the 34 patients in the matched chest tube group, 14 patients (41.2%) underwent chest tube removal on postoperative day 1, whereas the remaining 20 patients (58.8%) underwent removal on postoperative day 2 or later. Postoperative surveillance identified no pneumothorax in the no chest tube group. Mild subcutaneous emphysema occurred only sporadically and did not require treatment or pleural intervention. No patient in the no chest tube group required delayed chest tube insertion, and no patient in the chest tube group required tube reinsertion after removal.

Comparison of electronic patient-reported outcomes

Between group differences in patient-reported recovery were concentrated in the early postoperative period, particularly in symptom domains related to discomfort and recovery quality, a pattern that was also reflected in Figure S1. The clearest separation between groups was observed on postoperative day 2. Specifically, the no chest tube group reported lower scores for pain (2.79±2.11 vs. 4.08±2.07, P=0.03), restless sleep (1.98±1.86 vs. 3.49±2.32, P=0.01), and drowsiness (2.07±1.35 vs. 3.08±1.70, P=0.02) than the chest tube group. For the remaining postoperative symptoms, including cough, shortness of breath, fatigue, distress, difficulty walking, and activity limitation, no significant between group differences were detected at the monitored postoperative time points (all P>0.05; Table 3). Postoperative day 2 ePRO data were missing for 17 of the 68 matched patients (25.0%), including 9 of 34 patients in the no chest tube group and 8 of 34 patients in the chest tube group, mainly because of discharge before the scheduled in-hospital assessment. In a complete-case sensitivity analysis restricted to 20 matched pairs with observed data for both patients, the direction of the between-group differences remained consistent with the multiple-imputation analysis for all three outcomes (Table S2). Pain (2.50±2.12 vs. 4.20±2.21; P=0.04) and drowsiness (1.80±1.20 vs. 3.35±1.73; P=0.008) remained significantly lower in the no chest tube group, whereas restless sleep was lower but no longer reached statistical significance (1.95±1.88 vs. 3.40±2.50; P=0.08).

Comparison of measurements from wearable devices

Wearable monitoring further characterized the temporal physiologic recovery profile across the perioperative period and complemented the patient reported findings. As shown in Figure 3, physiologic trajectories recorded by wearable devices were broadly similar between groups, with differences limited to selected time points; detailed between-group comparisons at each perioperative time point are summarized in Table 4. The most notable between group difference was observed for oxygen saturation on postoperative day 1, which was higher in the no chest tube group than in the chest tube group (97.22%±1.64% vs. 96.05%±1.56%; P=0.003). Sleep quality scores were also higher in the no chest tube group on preoperative day 1 (80.19±6.53 vs. 75.75±6.68, P=0.009) and on the day of surgery (85.21±1.34 vs. 84.06±1.46, P<0.001). Body temperature on postoperative day 2 showed a borderline between group difference (36.65±0.16 vs. 36.75±0.22 ℃, P=0.053), whereas heart rate, step count, and the remaining wearable measures did not differ significantly between groups. In baseline adjusted sensitivity analyses that incorporated the corresponding preoperative value of each outcome, the differences in sleep quality on the day of surgery and oxygen saturation on postoperative day 1 remained materially unchanged, supporting the robustness of these findings.

Figure 3 Perioperative trends in measurements from wearable devices. (A) Mean oxygen saturation, (B) heart rate, and (C) body temperature are shown with 95% confidence intervals across perioperative time points. Oxygen saturation differed between groups on postoperative day 1.

Discussion

The main message of our findings is straightforward: after wedge resection, the signal associated with chest tube omission was more evident in early recovery experience than in broad physiologic change. In this post hoc secondary analysis of a prospectively real-world cohort, patients undergoing wedge resection with or without postoperative chest tube placement were compared using clinical, wearable, and patient-reported data. Patients managed without a chest tube had a shorter postoperative hospital stay and reported less pain, less restless sleep, and less drowsiness early after surgery, particularly on postoperative day 2. By contrast, physiologic measures recorded by wearable devices were broadly similar between groups, although oxygen saturation on postoperative day 1 was slightly higher in the no chest tube group. Taken together, these findings suggest that, after minimally invasive wedge resection, the benefit of omitting routine chest tube drainage may be reflected more clearly in symptom burden and perceived recovery than in broad physiologic measures.

In contemporary thoracic surgery, considerable effort has been directed not only toward reducing operative trauma itself but also toward minimizing the downstream burden of recovery (26). Within this context, our findings are clinically plausible. After wedge resection, overall surgical trauma is relatively limited; under these circumstances, the chest tube itself may become a comparatively important source of postoperative burden. Given that 14 of the 34 patients in the chest tube group underwent tube removal on postoperative day 1, the symptom differences observed on postoperative day 2 should not be interpreted as effects of an indwelling tube alone. Rather, they may reflect the broader chest-tube management experience, including ongoing drainage in some patients and residual wound or intercostal discomfort after tube removal in others. These mechanisms were not directly evaluated, and the postoperative day 2 findings should therefore be interpreted as associations with the chest-tube strategy rather than evidence of a direct device effect. The strongest supporting evidence concerns postoperative pain, and the direction of our findings is consistent with previous reports. A recent meta-analysis demonstrated that omission of routine chest drainage after VATS pulmonary resection was associated with significantly lower pain scores on postoperative days 1 to 3 (27). The same review also cited a study by Ueda et al. showing that omission of chest drainage preserved early ventilatory and exercise capacity (28). Data from selected series of VATS wedge resection have likewise suggested that a no drain strategy can safely accelerate rehabilitation in appropriately selected patients (10,29). More recent reviews of tubeless uniportal VATS have likewise identified omission of postoperative chest drainage as a key component of selected minimally invasive pathways, while emphasizing careful patient selection and the need for stronger prospective evidence (30).

This distribution of findings helps explain why patient-reported outcomes were the most informative endpoints in the present analysis. Previous studies of postoperative drainage have focused mainly on pain, safety, and postoperative hospital stay, with less attention to the broader profile of patient-reported recovery (27). Our study extends this literature by evaluating a wider range of symptoms, including sleep disturbance, distress, and activity limitation, although statistically significant differences in the matched cohort were confined to selected domains. Prior patient reported outcome studies have shown that these symptoms are common after lung cancer surgery and are closely associated with subsequent quality of life and functional recovery (19,31). Recent prospective cohort data comparing minimally invasive surgical approaches further demonstrated that patient-reported outcomes can reveal differences in fatigue, sleep disturbance, cough, and health-related quality of life that may not be fully captured by conventional perioperative measures (32). In this setting, patient reported measures may be more sensitive than broad physiologic indicators when an intervention primarily changes the lived burden of recovery rather than overall systemic stress. This interpretation is also consistent with randomized evidence showing that ePRO based postoperative symptom management after lung cancer surgery can reduce early symptom burden and complications while improving functional status for up to 1 year after discharge (18,19). The postoperative day 2 ePRO findings should nevertheless be interpreted cautiously because 17 of the 68 matched patients had missing assessments, mainly owing to discharge before the scheduled in-hospital assessment. In the complete-case analysis, all three outcomes showed directions consistent with the multiple-imputation analysis; pain and drowsiness remained statistically significant, whereas restless sleep did not, suggesting reduced precision in the smaller complete-case sample. Moreover, because patients with faster recovery may have been discharged before the scheduled postoperative day 2 assessment, the missing data may not have occurred at random.

The wearable findings also warrant cautious interpretation. In our cohort, between group differences in wearable based temperature, heart rate, oxygen saturation, sleep, and activity measures were few and small in absolute magnitude. Rather than diminishing the value of wearable monitoring, this pattern helps define its role in this clinical setting. After wedge resection, measurements from wearable devices may be most useful as a continuous objective layer of recovery assessment, whereas patient reported measures remain more sensitive to symptom burden and functional experience. This interpretation is supported by previous work in thoracic surgery showing high agreement between wearable measurements and conventional records, improved detection of outliers between routine observations, and meaningful associations between wearable metrics and ePRO severity (14). More broadly, the wearable literature supports the accuracy and acceptability of these devices for perioperative monitoring, and recent lung cancer data suggest that wearable based perioperative interventions may improve physical activity recovery and patient reported dyspnea after surgery (16,33,34). Taken together, these findings support wearable monitoring as an objective adjunct to postoperative recovery assessment that provides continuous physiologic and behavioral context while complementing, rather than replacing, patient-reported recovery.

Regarding conventional perioperative outcomes, the between group differences in our study were less pronounced than those observed for patient-reported recovery. This pattern is unsurprising in the setting of wedge resection, where baseline surgical trauma is already low and large separations in broad perioperative metrics may be less likely to emerge. In practical terms, the clearest traditional advantage was a shorter postoperative hospital stay, whereas broader perioperative separation remained limited. Although the postoperative hospital stay observed in our cohort may appear longer than that reported in some highly selected fast-track pathways, it was comparable with previous Chinese studies of thoracoscopic wedge resection, which reported postoperative stays of approximately 2 days in no-drain groups and 3 days in conventional chest tube groups (35-37). Previous studies have likewise shown that wedge resection is generally associated with favorable short term perioperative outcomes in selected patients (38). Nevertheless, the no chest tube group still showed advantages in selected traditional outcomes, supporting the view that omission of routine drainage may reduce part of the postoperative management burden even when the procedure itself is highly minimally invasive. This interpretation is broadly consistent with previous no drain studies and meta analyses, which have mainly reported less early postoperative pain, comparable safety, and shorter postoperative hospital stay or faster rehabilitation in selected patients rather than consistent advantages across all perioperative parameters (5,10,27,39,40).

This perspective is important because it treats recovery as a longitudinal process rather than as a set of isolated perioperative events. Beyond the comparison of chest tube strategies itself, the broader value of this study lies in the way postoperative recovery was assessed. Conventional perioperative evaluation still relies largely on intermittent bedside observations and a limited set of static endpoints, which may fail to capture short lived physiologic changes or the patient’s evolving recovery experience (14). By integrating wearable signals, ePROs, and conventional clinical outcomes, our study evaluated recovery as a longitudinal, multidimensional, and patient centered process rather than as a series of isolated measurements. From a translational perspective, this framework may support more individualized postoperative monitoring and provide a practical basis for remote follow up and future recovery pathways aligned with enhanced recovery after surgery (ERAS) principles.

This study has several limitations. First, its single center, nonrandomized design leaves the possibility of residual confounding despite propensity score matching and missing data handling. Although the clinical, wearable, and ePRO data were collected prospectively, the wedge-resection chest-tube comparison was not prespecified in the original registry. The post hoc restriction to this analytic subgroup may have introduced additional selection bias and limits the confirmatory interpretation of the findings. Because all patients were treated in a single center and selected for M0 wedge resection, the findings should be generalized cautiously to other centers, more extensive pulmonary resections, patients with more advanced disease, or settings using different wearable or ePRO systems. Second, the sample size was modest, which may have reduced the robustness of between group comparisons for outcomes with small absolute differences. Third, although some observed differences, particularly among wearable measures, reached statistical significance, their clinical relevance requires careful consideration given the small absolute magnitude of the between group differences. Fourth, the present analysis focused mainly on early postoperative recovery and did not include longer term pulmonary function, chronic pain, or oncologic outcomes. Finally, although ePRO collection improved the granularity of postoperative assessment, symptom reporting remains inherently subjective and may still be influenced by individual expectations, response tendencies, and contextual factors.

Conclusions

This study highlights the value of a multimodal digital platform for assessing postoperative recovery after wedge resection. By integrating wearable signals, ePROs, and conventional perioperative outcomes, recovery could be characterized more longitudinally and more comprehensively than with isolated clinical measurements alone. Within this framework, omission of routine chest tube drainage was associated primarily with a more favorable patient-reported recovery profile, whereas physiologic differences measured by wearable devices were modest. These findings suggest that digitally enabled multimodal assessment may provide a practical approach to postoperative monitoring after minimally invasive thoracic surgery and may help inform future patient centered drain management strategies.

Acknowledgments

The authors thank all participating patients and the clinical staff involved in perioperative data collection.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2026-0758/rc

Peer Review File: Available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2026-0758/prf

Funding: This work was supported by The Science and Technology Innovation Committee Joint Funding (Dengfeng Hospital) Project of Guangzhou (No. 2023A03J0356).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2026-0758/coif). K.C. is an employee of Shanghai CinoCore Health Technology Co., Ltd. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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