Skip to main content
SpringerLink
Log in

Prediction of prolonged air leak after lung resection using continuous log data of flow by digital drainage system

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to extract predictive factors of prolonged air leak (PAL) including air flow data as objective parameter by digital drainage system (DDS).

Methods

The 372 patients who underwent lung resection and had continuous log data of air flow by DDS were reviewed. PAL was defined as the air leak which was exceeding 20 ml/min and lasting 5 days or more. The 69 patients (18.5%) showed air leak and were divided into PAL group (n = 21) and non-PAL group (n = 48). The average flow per hour was calculated at 0, 12, and 24 postoperative hours (POH) and the residual ratio of flow at 12, 24, and 36 POH to that at the time after surgery was analyzed with clinical factors. Area under the receiver-operating characteristic curve (ROC-AUC) was calculated to determine optimal cut-off value of PAL predictors.

Results

ROC-AUC for flow at 36 POH was 0.88. Sensitivity and specificity were 0.91 and 0.73 when cut-off value was set at 20 mL/min at 36 POH. ROC-AUC for residual ratio at 36 POH was 0.82. Sensitivity and specificity were 0.81 and 0.79 when cut-off value of residual ratio was set at 0.20.

Conclusions

The air flow and the residual ratio measured by DDS will be useful predictors of postoperative PAL after lung resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Cerfolio RJ, Bass CS, Pask AH, Katholi CR. Predictors and treatment of persistent air leaks. Ann Thorac Surg. 2002;73:1727–30. (discussion 30–1).

    Article  PubMed  Google Scholar 

  2. Brunelli A, Varela G, Refai M, Jimenez MF, Pompili C, Sabbatini A, et al. A scoring system to predict the risk of prolonged air leak after lobectomy. Ann Thorac Surg. 2010;90:204–9.

    Article  PubMed  Google Scholar 

  3. Orsini B, Baste JM, Gossot D, Berthet JP, Assouad J, Dahan M, et al. Index of prolonged air leak score validation in case of video-assisted thoracoscopic surgery anatomical lung resection: Results of a nationwide study based on the French national thoracic database, epithor. Eur J Cardiothorac Surg. 2015;48:608–11.

    Article  PubMed  Google Scholar 

  4. Attaar A, Winger DG, Luketich JD, Schuchert MJ, Sarkaria IS, Christie NA, et al. A clinical prediction model for prolonged air leak after pulmonary resection. J Thorac Cardiovasc Surg. 2016. https://doi.org/10.1016/j.jtcvs.2016.10.003.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Varela G, Jimenez MF, Novoa NM, Aranda JL. Postoperative chest tube management: Measuring air leak using an electronic device decreases variability in the clinical practice. Eur J Cardiothorac Surg. 2009;35:28–31.

    Article  PubMed  Google Scholar 

  6. Bertolaccini L, Rizzardi G, Filice MJ, Terzi A. ‘Six sigma approach’—an objective strategy in digital assessment of postoperative air leaks: a prospective randomised study. Eur J Cardiothorac Surg. 2011;39:e128-32.

    Article  PubMed  Google Scholar 

  7. Petrella F, Rizzo S, Radice D, Borri A, Galetta D, Gasparri R, et al. Predicting prolonged air leak after standard pulmonary lobectomy: computed tomography assessment and risk factors stratification. Surgeon. 2011;9:72–7.

    Article  PubMed  Google Scholar 

  8. Pompili C, Brunelli A, Salati M, Refai M, Sabbatini A. 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. (discussion 93).

    Article  PubMed  Google Scholar 

  9. Brunelli A, Salati M, Pompili C, Refai M, Sabbatini A. Regulated tailored suction vs regulated seal: a prospective randomized trial on air leak duration. Eur J Cardiothorac Surg. 2013;43:899–904.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. Shoji F, Takamori S, Akamine T, Toyokawa G, Morodomi Y, Okamoto T, et al. Clinical evaluation and outcomes of digital chest drainage after lung resection. Ann Thorac Cardiovasc Surg 2016;22:354–58. (advpub).

    Article  PubMed  PubMed Central  Google Scholar 

  12. Attaar A, Winger DG, Luketich JD, Schuchert MJ, Sarkaria IS, Christie NA, et al. A clinical prediction model for prolonged air leak after pulmonary resection. J Thorac Cardiovasc Surg. 2017;153:690–99 e2.

    Article  PubMed  Google Scholar 

  13. Rivera C, Bernard A, Falcoz PE, Thomas P, Schmidt A, Benard S, et al. Characterization and prediction of prolonged air leak after pulmonary resection: a nationwide study setting up the index of prolonged air leak. Ann Thorac Surg. 2011;92:1062–8. (discussion 68).

    Article  PubMed  Google Scholar 

  14. Brunelli A, Cassivi SD, Salati M, Fibla J, Pompili C, Halgren LA, et al. Digital measurements of air leak flow and intrapleural pressures in the immediate postoperative period predict risk of prolonged air leak after pulmonary lobectomy. Eur J Cardiothorac Surg. 2011;39:584–8.

    Article  PubMed  Google Scholar 

  15. Bille A, Borasio P, Gisabella M, Errico L, Lausi P, Lisi E, et al. Air leaks following pulmonary resection for malignancy: risk factors, qualitative and quantitative analysis. Interact Cardiovasc Thorac Surg. 2011;13:11–5.

    Article  PubMed  Google Scholar 

  16. Takamochi K, Imashimizu K, Fukui M, Maeyashiki T, Suzuki M, Ueda T, et al. Utility of objective chest tube management after pulmonary resection using a digital drainage system. Ann Thorac Surg. 2017;104:275–83.

    Article  PubMed  Google Scholar 

  17. Pompili C, Detterbeck F, Papagiannopoulos K, Sihoe A, Vachlas K, Maxfield MW, et al. Multicenter international randomized comparison of objective and subjective outcomes between electronic and traditional chest drainage systems. Ann Thorac Surg. 2014;98:490–6. (discussion 96–7).

    Article  PubMed  Google Scholar 

  18. Ciccone AM, Meyers BF, Guthrie TJ, Davis GE, Yusen RD, Lefrak SS, et al. Long-term outcome of bilateral lung volume reduction in 250 consecutive patients with emphysema. J Thorac Cardiovasc Surg. 2003;125:513–25.

    Article  PubMed  Google Scholar 

Download references

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan

    Masaki Goto, Keiju Aokage, Keigo Sekihara, Tomohiro Miyoshi, Kenta Tane & Masahiro Tsuboi

  2. Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Masaki Goto & Kohei Yokoi

Authors
  1. Masaki Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keiju Aokage
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keigo Sekihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tomohiro Miyoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenta Tane
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kohei Yokoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masahiro Tsuboi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Keiju Aokage.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 144 KB)

Supplementary material 2 (PDF 121 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goto, M., Aokage, K., Sekihara, K. et al. Prediction of prolonged air leak after lung resection using continuous log data of flow by digital drainage system. Gen Thorac Cardiovasc Surg 67, 684–689 (2019). https://doi.org/10.1007/s11748-019-01073-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-019-01073-y

Keywords

Search

Navigation