Tunneled chest tube placement associated with lower pain after uniportal VATS lobectomy in retrospective cohort

BackgroundChest tube placement is a routine but critical component of uniportal video-assisted thoracoscopic surgery (VATS). The routine method places the chest tube directly through the working incision, which may exacerbate acute postoperative pain. Multiple modified placement strategies have been proposed, yet evidence evaluating their comparative effectiveness on pain outcomes remains limited. This study examined the association between a newly proposed modified same-intercostal chest tube placement and acute postoperative pain following uniportal VATS lobectomy.MethodsThis retrospective cohort study included adult patients undergoing elective uniportal VATS lobectomy at a tertiary medical center in Beijing, China, from June 2021 to June 2023. Among 1,701 screened patients, 1,082 met inclusion criteria. The exposure was tunneled same-intercostal chest tube placement, which creates a short subcutaneous and intramuscular tunnel along the superior border of the lower rib without traversing the rib or accessing an adjacent intercostal space. The primary outcomes were moderate-to-severe pain at rest within the first 24 hours. Propensity score overlap weighting was applied to achieve baseline covariate balance. Weighted logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Pragmatic care-adjusted sensitivity analyses incorporated both baseline covariates and postoperative covariates.ResultsThe modified technique was associated with a lower rate of moderate-to-severe pain (16.8% vs. 27.1%). In weighted multivariable logistic regression analyses, modified technique was associated with 48% lower odds of acute postoperative pain (adjusted odds ratio [aOR] = 0.52, 95% CI = 0.35-0.79, p = 0.002) and a 38% lower adjusted risk (risk ratio [RR] = 0.62, 95% CI: 0.43-0.81, p