Objective Evaluation of Tubeless Thoracic Surgery in Early-Stage Lung Cancer Patients Using Multimodal Digital Device: A Prospective Study.

Abstract

Limited research has objectively assessed perioperative outcomes of tubeless thoracic surgery. This prospective study compared perioperative outcomes between tubeless and intubated surgery using a multimodal digital platform integrating a wearable device and electronic patient-reported outcomes (ePROs). Of 337 patients, 263 were enrolled and instructed to wear a wearable device and complete ePROs. Propensity score matching (PSM) was applied to balance baseline characteristics. After PSM, 80 patients were included in each group. Compared with the intubation group, the tubeless group had shorter hospital length of stay (2.78 vs 3.91 days, P < .001), shorter chest tube duration (0.93 vs 2.26 days, P < .001), and lower drainage volume (128.90 vs 313.88 mL, P < .001). Wearable devices captured significant differences, with the tubeless group showing lower body temperature (36.68 °C vs 36.79 °C, P <.01) and heart rate (78.96 beats/min vs 85.23 beats/min, P < .001) on the second postoperative day. Oxygen saturation was higher in the tubeless group on postoperative day 1 (96.71% vs 95.95%, P < .001) and day 2 (96.39% vs 95.81%, P = .05). Sleep quality was better the day before (78.59 vs 75.74, P = .01) and on surgery day (85.48 vs 83.15, P < .001). ePROs reported less pain, coughing, dyspnea, and distress in the tubeless group. We validated a multimodal digital platform for perioperative assessment. Wearable-derived metrics showed modest variation, supporting feasibility rather than clinical superiority, whereas ePROs revealed differences suggesting tubeless surgery may offer a more favorable experience.