Cost-savings per person: 751 €
Cost-savings per 500 patients: 375'500 €
Based on: Significantly reduced of LOS from 6 days with traditional system to 4.5 days with Thopaz (from € 1802 to € 2553; p=0.0002)
Reference: Pompili C, Brunelli A, Salati M, et al. Impact of the learning curve in the use of a novel electronic chest drainage system after pulmonary lobectomy: a case-matched analysis on the duration of chest tube usage. Interact Cardiovasc Thorac Surg 2011;13:490–3.

Cost-savings per person: 1'430 €
Cost-savings per 500 patients: 715'000 €
Based on: Significantly reduced median LOS from 4.34 days with traditional system to 3.37 days with Thopaz; p<0.0001, median chest tube removal time (from 91.3 hours to 67.6 hours; p<0.0001), total cost, median (from $21'342 to $ 19'800; p=0.0001) and inpatient-stay cost, median (from $ 7'417 to $ 5'749; p=0.0001) 
Reference: Han S, Du S, Jander C, et al. The impact of an enhanced recovery after surgery pathway for video-assisted and robotic-assisted lobectomy on surgical outcomes and costs: a retrospective single-center cohort study. J Robotic Surg 2023;17(3):1039-48.
ERAS: Enhanced Recovery After Surgery, VATS: Video assisted thoracic surgery.

Cost-savings per person: 4'340 €
Cost-savings per 500 patients: 2'170'000 €
Based on: Significantly reduced median LOS from 2.41 days with traditional system to 1.35 days with Thopaz; p<0.0001, median chest tube removal time (from 44.50 hours to 20.35 hours; p<0.0001), total cost, median (from $18'664 to $ 13'588; p=0.0001) and inpatient-stay cost, median (from $ 4'028 to $ 2'247; p=0.0001) 
Reference: Han S, Du S, Jander C, et al. The impact of an enhanced recovery after surgery pathway for video-assisted and robotic-assisted lobectomy on surgical outcomes and costs: a retrospective single-center cohort study. J Robotic Surg 2023;17(3):1039-48.
ERAS: Enhanced Recovery After Surgery, RATS: Robotic assisted thoracic surgery.

Cost-savings per person: 2'275 €
Cost-savings per 500 patients: 1'137'500 €
Based on: Significantly reduced median LOS from 5 days with traditional system to 4 days with Thopaz; p=0.004, leading to a cost savings of $ 2659 per hospital day.
Reference: Patel C, Ruppert SD, Cao H, et al. Use of a Digital Air Leak Detection Device to Decrease Chest Tube Duration. Crit Care Nurse 2023;43(6):11-21.
POS: post-operative day.

Cost-savings per person: 430 €
Cost-savings per 500 patients: 215'000 €
Based on: Significantly reduced median drainage duration (75 hours with traditional system to 42.5 hours with Thopaz; p=0.000039), median hospitalization time from 7 days with traditional system to 5 days with Thopaz; p<0.0005. Significant reduction in postsurgical care (cost of drugs (p<0.001) and cost of hospitalization (p<0.00005), which result in the decrease of final cost of treatment (p<0.05).
Reference: Jablonski S, Brocki M, Wawrzycki M, et al. Efficacy assessment of the drainage with permanent airflow measurement in the treatment of pneumothorax with air leak. Thorac Cardiovasc Surg 2014;62:509–15.

Cost-savings per person: 55 €
Cost-savings per 500 patients: 27'500 €
Based on: Significantly reduced costs of hospitalization based on calculation from the diagnosis procedure combination (DPC) component and the fee-for-service (FFS) component. Median hospitalization costs from $ 271.90 with traditional system to $ 207.50 with Thopaz; p=0.004. 
The DPC component was calculated as follows: 
(Daily score per DPC groups) x (coefficient by medical institution) x (length of hospitalization) x 10 (Japanese yen).One United States dollar (USD) was calculated as 110 Japanese Yen.
Reference: Yagi S, Miwa H, Kono M, et al. Comparison of clinical utility between digital and analog drainage systems in patients with spontaneous pneumothorax. Resp Investig 2022;60(6):840-6.

Cost-savings per person: 103 €
Cost-savings per 500 patients: 51'500 €
Based on: Significantly reduced costs of hospitalization based on calculation from the diagnosis procedure combination (DPC) component and the fee-for-service (FFS) component.Median hospitalization costs from $ 362.60 with traditional system to $ 242.50 with Thopaz; p=0.014.
The DPC component was calculated as follows: 
(Daily score per DPC groups) x (coefficient by medical institution) x (length of hospitalization) x 10 (Japanese yen).One United States dollar (USD) was calculated as 110 Japanese Yen.
Reference: Yagi S, Miwa H, Kono M, et al. Comparison of clinical utility between digital and analog drainage systems in patients with spontaneous pneumothorax. Resp Investig 2022;60(6):840-6.

Underwater seal drain (analog unit)
Subjective counting bubbles. Removal criteria variable, often no bubbles in 12–24 hours

Thopaz⁺
Objective display in ml/min with trending graphs. Removal criteria can be defined objectively with ml/min in a specified

Underwater seal drain (analog unit)
Reading amount on collection chamber. Removal criteria often based on surgeon’s experience

Thopaz⁺
Objective display in ml with trending graphs. Evidence-based research ongoing to remove this criteria and rely solely on objective air leak criteria, reducing chest drain duration and length of stay

Underwater seal drain (analog unit)
Drainage duration / length of hospital stay (LOS)
Subjective removal criteria and variable outcomes

Thopaz⁺
Objective digital drainage removal criteria improves outcomes

Underwater seal drain (analog unit)
Initial investment / Costs
Perceived cost benefits. Long length of stay and low patient satisfaction not considered

Thopaz⁺
Thopaz+ seems more expensive. When improved outcomes and satisfaction are taken into account, cost-savings are substantial. Different pricing models available to suit your needs.

2023 Sørensen MF, Holbek BL, Petersen RH, Christensen TD. What is the optimal level of suction on digital chest drainage devices following pulmonary lobectomy? Interact CardioVasc Thorac Surg 2021; doi:10.1093/icvts/ivab028.

2023 Vasconcelos-Castro S, Borges-Dias M, Soares-Oliveira M. Digital Thoracic Drainage System: A New Tool For Pediatric Thoracic Surgery. Rev Port Cir Cardiotorac Vasc [Internet]. 2023;29(4):21-5.

2023 Zhou L, Guo K, Shang X, et al. Advantages of applying digital chest drainage system for postoperative management of patients following pulmonary resection: a systematic review and meta-analysis of 12 randomized controlled trials. Gen Thorac Cardiovasc Surg 2023;71:1-11. https://doi.org/10.1007/s11748-022-01875-7

2023 Aprile V, Bacchin D, Calabrò F, et al. Intraoperative prevention and conservative management of postoperative prolonged air leak after lung resection: a systematic review. J of Thorac Dis 2023;15(2): 878.

2023 Batchelor, TJP. Enhanced recovery after surgery and chest tube management. J Thorac Dis 2023;15(2):901-908.

2022 Izaaryene J, Dassa M, Orsini B et al. Initial Experience of Digital Air Leak Quantification in Interventional Radiology. Cardiovasc Intervent Radiol 2022;45:1750–1754. https://doi.org/10.1007/s00270-022-03190-3

2022 Chang PC, Chen, KH, Jhou HJ, Lee CH, Chou SH, Chen PH, Chang TW. Promising effects of digital chest tube drainage system for pulmonary resection: a systematic review and network meta-analysis. Journal of Personalized Medicine 2022;12(4):512.

2022 Tamura K., Sakurai S. Clinical efficacy of digital chest drainage system in cardiac valve surgery. Gen Thorac Cardiovasc Surg 2022;70:619–623. https://doi.org/10.1007/s11748-021-01752-9

2021 Pawelkowska, K, et al. Early experience with the Thopaz+ chest drainage system–is this a new era in the management of post-cardiotomy bleeding?. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery 2021;18(4): 236-238.

2021 Eriguchi D, Ito H, Nagashima T, Adachi H, Samejima J, Nemoto D et al. Usefulness of monitoring intrapleural pressure with digital chest drainage system for the management of airleakage after lung resection. Interact CardioVasc Thorac Surg 2021; doi:10.1093/icvts/ivab122.

2021 Mitsui S, Tauchi S, Uchida T, et al. Low suction on digital drainage devices promptly improves post-operative air leaks following lung resection operations: a retrospective study. J Cardiothorac Surg 2021; 16(105) https://doi.org/10.1186/s13019-021-01485-z

2020 Alam MS, Haseen, MA, Aslam M, Beng MH. Use of Thopaz in patients of empyema thoracis undergoing decortication. Lung. India 2020 (37):511–517.

2020 Saha S, Hofmann S, Jebran AF, et al. Safety and efficacy of digital chest drainage units compared to conventional chest drainage units in cardiac surgery. Interact CardioVasc Thorac Surg 2020;31(1):42-47.

2020 Ruigrok D, Kunst PWA, Blacha MMJ, et al. Digital versus analogue chest drainage system in patients with primary spontaneous pneumothorax: a randomized controlled trial. BMC Pulmonary Medicine 2020; 20:136

2020 Barozzi L, Biagio LS, Meneguzzi M, et al. Novel, digital, chest drainage system in cardiac surgery. J Card Surg. 2020;1–6.2020Pfeuty K, Lenot B. Early postoperative day 0 chest tube removal using a digital drainage device protocol after thoracoscopic major pulmonary resection. Interact CardioVasc Thorac Surg 2020; doi:10.1093/icvts/ivaa170.

2019 Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERASVR). Society and the European Society of Thoracic Surgeons (ESTS) Eur J Cardiothorac Surg. 2019;55:91–115.

2019 Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery Society recommendations. JAMA Surg 2019; 154: 755–766.

2019 Holbek BL, Christensen M, Hansen HJ, et al. The effects of low suction on digital drainage devices after lobectomy using video-assisted thoracoscopic surgery: a randomized controlled trialdagger. Eur J Cardiothorac Surg 2019;55:673–81.

2019 Wang H, Hu W, Ma L, et al. Digital chest drainage system versus traditional chest drainage system after pulmonary resection: A systematic review and meta-analysis. J Cardiothorac Surg 2019;14:13

2019 Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery Society recommendations. JAMA Surg 2019;154:755–766.

2019 Van Linden A, Hecker F, Courvoisier DS, et al. Reduction of drainage-associated complications in cardiac surgery with a digital drainage system: a randomized controlled trial. J Thorac Dis 2019;11(12):5177-5186.

2019 Pérez-Egido L, Antonia MA, García-Casillasa, Simal I, et al. Digital thoracic drainage: a new system to monitor air leaks in pediatric population. J Pediatr Surg 2019;54(4):693–695.

2019 Jacobsen K, Talbert S, Boyer JH. The benefits of digital drainage system versus traditional drainage system after robotic-assisted pulmonary lobectomy. J Thorac Dis 2019;11(12): 5328–5335.

2019 Hallifax RJ, Laskawiec-Szkonter M, Rahman NM. Predicting outcomes in primary spontaneous pneumothorax using air leak measurements. Thorax 2019;74:410–412.

2018 Evans JM, Ray A, Dale M, et al. Thopaz+ portable digital system for managing chest drains: A NICE Medical Technology Guidance. Appl Health Econ Health Policy 2019;17(3):285–94.

2018 Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERASVR). Society and the European Society of Thoracic Surgeons (ESTS) Eur J Cardiothorac Surg 2019;55:91–115.

2018 Zhou J, Lyu M, Chen N, et al. Digital chest drainage is better than traditional chest drainage following pulmonary surgery: a meta-analysis. Eur J Cardiothorac Surg 2018;54:635–42.

2017 Yeung, C, Ghazel, M, French, D. Forecasting pulmonary air leak duration following lung surgery using transpleural airflow data from a digital pleural drainage device. J Thorac Dis 2018; 10(Suppl 32): 3747–3754.

2016 Pompili C, Salati M, Refai M, et al. Recurrent air leak soon after pulmonary lobectomy: an analysis based on an electronic airflow evaluation. Eur J Cardiothorac Surg. 2016;49:1091–4.

2016 Shiroyama T, Okamoto N, Tamiya M, et al. Effective Management of Persistent Pneumothorax Using a Thopaz Digital Drainage System Combined with an Endobronchial Watanabe Spigot. Intern Med 2016;55:663-5.

2016 Bakhos C, Doelken P, Pupovac S, et al. Management of prolonged pulmonary air leaks with endobronchial valve placement. JSLS 2016;20: e2016.00055.

2016 Costa AD Jr, Bachichi T, Holanda C, Rizzo LA. An initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery. Jornal Brasileiro De Pneumologia: Publicacao Oficial Da Sociedade Brasileira De Pneumologia E Tisilogia. 2016;42(6):444–6.

2016 Miller DL, Helms GA, Mayfield WR. Digital drainage system reduces hospitalization after video-assisted thoracoscopic surgery lung resection. Ann Thorac Surg 2016;102:955-61.2016Wei B, Cerfolio RJ. Clinical pathway for thoracic surgery in the United States. J Thorac Dis. 2016;8:S29eS36.

2016 Sihoe AD. Uniportal video-assisted thoracic (VATS) lobectomy. Ann Cardiothorac Surg 2016;5:133–44.

2016 Khan AZ, Pillai GG. From 200 BC to 2015 AD: an integration of robotic surgery and Ayurveda/Yoga. J Thorac Dis 2016;8:S84–92.

2016 Sihoe A, Yu P, Lee K, Liu X. Adherence to a clinical pathway for video-assisted thoracic surgery: predictors and clinical importance. Innovations 2016;11:179–86.

2016 Shoji F, Takamori S, Akamine T, et al. Clinical evaluation and outcomes of digital chest drainage after lung resection. Ann Thorac Cardiovasc Surg 2016;22(6):354–358.

2016 Refai M, Salati M, Tiberi M, et al. Clinical pathway for thoracic surgery in an Italian centre. J Thorac Dis 2016;8:23-8.

2016 George RS, Papagiannopoulos K. Advances in chest drain management in thoracic disease. J Thorac Dis 2016;8:55-64.

2016 Drahush N, Miller AD, Smith JS, et al. Standardized approach to prolonged air leak reduction after pulmonary resection. Ann Thorac Surg. 2016;101(6):2097–2101.

2015 Lijkendijk M, Licht PB, Neckelmann K. Electronic versus traditional chest tube drainage following lobectomy: a randomized trial. Eur J Cardiothorac Surg 2015;48:893–8.

2015 Chavarín A., Molins L., Mier J.M., et al. The Role of Ultrasound and Air Leak Measurement in Assessing Lung Expansion after Thoracic Surgery. Surgical Science 2015, 6, 352-357.

2015 Southey D, Pullinger D, Loggos S, et al. Discharge of thoracic patients on portable digital suction: Is it cost-effective? Asian Cardiovasc Thorac Ann 2015;23:832-8.

2015 Brocki BC, Andreasen JJ, Langer D, et al. Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: a randomized controlled trial. Eur J Cardiothorac Surg 2016;49:1483-91.

2015 Gilbert S, McGuire AL, Maghera S, et al. Randomized trial of digital versus analog pleural drainage in patients with or without a pulmonary air leak after lung resection. J Thorac Cardiovasc Surg 2015;150:1243–9.

2015 Pompili C, Xiumè F, Hristova R, et al. Regulated drainage reduces the incidence of recurrence after uniportal video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax: a propensity case-matched comparison of regulated and unregulated drainage. Eur J Cardiothorac Surg 2016;49:1127–31.

2015 Cafarotti S, Cusumano G, Giuliani M, et al. Extraanatomical VATS lung resection: the outpatient experience with the aid of a digital chest drain device. Eur Rev Med Pharmacol Sci 2015;19:3850-4.

2015 Mesa-Guzman M, Periklis P, Niwaz Z, et al. Determining optimal fluid and air leak cut-off values for chest drain management in general thoracic surgery. J Thorac Dis 2015;7:2053-7.

2014 Jablonski S, Brocki M, Wawrzycki M, et al. Efficacy assessment of the drainage with permanent airflow measurement in the treatm

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