8F small-bore versus conventional 24F chest drainage strategies within a standardized thoracic ERAS pathway after Uniportal VATS pulmonary resection.

OBJECTIVES: To evaluate associations between an 8F small-bore drainage strategy and short-term recovery compared with conventional 24F chest tube drainage after uniportal video-assisted thoracoscopic surgery pulmonary resection within an enhanced recovery after surgery pathway. METHODS: We retrospectively studied 217 consecutive pulmonary nodule patients undergoing uniportal video-assisted thoracoscopic surgery pulmonary resection from April 2023 to June 2025. Drain selection reflected routine preference of two senior surgeon teams, not randomization or temporal protocol change. Primary outcomes were postoperative day 3 visual analogue scale pain, chest tube duration, and length of stay. Multivariable regression, inverse probability of treatment weighting, procedure subgroups, and Spearman correlations were used; secondary and exploratory outcomes were interpreted without multiplicity adjustment. RESULTS: For median outcomes, bracketed values denote [1st quartile; 3rd quartile]. The 8F group (n = 97) had lower postoperative day 3 pain (2 [2; 4] vs 3 [2; 4], P = 0.018), shorter tube duration (2 [2; 2] vs 2 [2; 3] days, P < 0.001), and shorter length of stay (4 [4; 5] vs 5 [4; 6] days, P < 0.001) than the 24F group (n = 120). No reinsertion, additional pleural intervention, prolonged air leak, or 30-day readmission occurred. Weighted estimates remained consistent for tube duration and length of stay. CONCLUSIONS: In this retrospective cohort, the 8F strategy was associated with faster short-term recovery. Because drain caliber, insertion site, and fixation differed and allocation was non-randomized, findings are hypothesis-generating rather than proof of causal superiority or safety equivalence.