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Predictive factors and economic impact of prolonged air leak after pulmonary resection

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Abstract

Objective

Prolonged air leak (PAL) is one of the most common complications after pulmonary resection for lung cancer. This study aimed to identify the factors that predict PAL, and to evaluate the impact of PAL on the development of additional complications and cost of hospitalization.

Methods

A total of 2278 patients who underwent pulmonary resection other than pneumonectomy for lung cancer from 2014 to 2018 were retrospectively enrolled in this study. PAL was defined as air leak that continued more than 5 days after the operation. Multivariate analyses were conducted to identify significant predictors of PAL, using clinical information. Development of complications other than PAL, and cost of hospitalization care were also analyzed.

Results

PAL was observed in 91 (4.0%) cases. Multivariate logistic regression analysis revealed that the presence of intrathoracic adhesion (odds ratio [OR] 4.476, p < 0.001), smoking history > 20 pack-year (OR 2.441, p = 0.005), male sex (OR 2.269, p = 0.013), and lobectomy or bilobectomy (OR 1.935, p = 0.025) were significant risk factors for PAL. The presence of PAL was related to the development of additional complications (p < 0.001). The cost of hospitalization care in patients with PAL was about 1.3 times higher than that in patients without PAL (p < 0.001).

Conclusions

PAL is related to additional complications and higher cost of hospitalization care. Surgeons should pay careful attention to minimize the incidence of PAL in patients with risk factors including intrathoracic adhesion, history of heavy smoking, male sex, and lobectomy or bilobectomy.

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References

  1. Attaar A, Luketich JD, Schuchert MJ, Winger DG, Sarkaria IS, Nason KS. Prolonged air leak after pulmonary resection increases risk of noncardiac complications, readmission, and delayed hospital discharge: a propensity score-adjusted analysis. Ann Surg. 2019;273:163–72. https://doi.org/10.1097/SLA.0000000000003191.

    Article  Google Scholar 

  2. Goto M, Aokage K, Sekihara K, Miyoshi T, Tane K, Yokoi 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. 2019;67:684–9.

    Article  Google Scholar 

  3. Attaar A, Tam V, Nason KS. Risk factors for prolonged air leak after pulmonary resection: a systematic review and meta-analysis. Ann Surg. 2019. https://doi.org/10.1097/SLA.0000000000003560.

    Article  Google Scholar 

  4. Kunou H, Kanzaki R, Kawamura T, Kanou T, Ose N, Funaki S, et al. Two cases of air leak syndrome after bone marrow transplantation successfully treated by the pleural covering technique. Gen Thorac Cardiovasc Surg. 2019;67:987–90.

    Article  Google Scholar 

  5. Liang S, Ivanovic J, Gilbert S, Maziak DE, Shamji FM, Sundaresan RS, et al. Quantifying the incidence and impact of postoperative prolonged alveolar air leak after pulmonary resection. J Thorac Cardiovasc Surg. 2013;145:948–54.

    Article  Google Scholar 

  6. Cerfolio RJ, Bass CS, Pask AH, Katholi CR. Predictors and treatment of persistent air leaks. Ann Thorac Surg. 2002;73:1727–31 (discussion 30-1).

    Article  Google Scholar 

  7. 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  Google Scholar 

  8. Liberman M, Muzikansky A, Wright CD, Wain JC, Donahue DM, Allan JS, et al. Incidence and risk factors of persistent air leak after major pulmonary resection and use of chemical pleurodesis. Ann Thorac Surg. 2010;89:891–8 (discussion 97-8).

    Article  Google Scholar 

  9. 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  Google Scholar 

  10. Elsayed H, McShane J, Shackcloth M. Air leaks following pulmonary resection for lung cancer: is it a patient or surgeon related problem? Ann R Coll Surg Engl. 2012;94:422–7.

    Article  CAS  Google Scholar 

  11. Gilbert S, Maghera S, Seely AJ, Maziak DE, Shamji FM, Sundaresan SR, et al. Identifying patients at higher risk of prolonged air leak after lung resection. Ann Thorac Surg. 2016;102:1674–9.

    Article  Google Scholar 

  12. Pompili C, Falcoz PE, Salati M, Szanto Z, Brunelli A. A risk score to predict the incidence of prolonged air leak after video-assisted thoracoscopic lobectomy: An analysis from the European Society of Thoracic Surgeons database. J Thorac Cardiovasc Surg. 2017;153:957–65.

    Article  Google Scholar 

  13. Zhao K, Mei J, Xia C, Hu B, Li H, Li W, et al. Prolonged air leak after video-assisted thoracic surgery lung cancer resection: risk factors and its effect on postoperative clinical recovery. J Thorac Dis. 2017;9:1219–25.

    Article  Google Scholar 

  14. Murakami J, Ueda K, Tanaka T, Kobayashi T, Hamano K. Grading of emphysema is indispensable for predicting prolonged air leak after lung lobectomy. Ann Thorac Surg. 2018;105:1031–7.

    Article  Google Scholar 

  15. Seder CW, Basu S, Ramsay T, Rocco G, Blackmon S, Liptay MJ, et al. A prolonged air leak score for lung cancer resection: an analysis of the Society of Thoracic Surgeons general thoracic surgery database. Ann Thorac Surg. 2019;108:1478–83.

    Article  Google Scholar 

  16. Asamura H. Minimally invasive open surgery approach for the surgical resection of thoracic malignancies. Thorac Surg Clin. 2008;18:269–73 (vi).

    Article  Google Scholar 

  17. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  Google Scholar 

  18. Inoue H, Nishiyama N, Mizuguchi S, Nagano K, Izumi N, Komatsu H, et al. Clinical value of exogenous factor XIII for prolonged air leak following pulmonary lobectomy: a case control study. BMC Surg. 2014;14:109.

    Article  Google Scholar 

  19. Felip E, Ardizzoni A, Ciuleanu T, Cobo M, Laktionov K, Szilasi M, et al. Checkmate 171: a phase 2 trial of nivolumab in patients with previously treated advanced squamous non-small cell lung cancer, including ECOG PS 2 and elderly populations. Eur J Cancer. 2020;127:160–72.

    Article  CAS  Google Scholar 

  20. Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr. 2000;72:694–701.

    Article  CAS  Google Scholar 

  21. Celli BR, MacNee W, Force AET. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932–46.

    Article  CAS  Google Scholar 

  22. Remen T, Pintos J, Abrahamowicz M, Siemiatycki J. Risk of lung cancer in relation to various metrics of smoking history: a case-control study in Montreal. BMC Cancer. 2018;18:1275.

    Article  CAS  Google Scholar 

  23. Gomez-Caro A, Calvo MJ, Lanzas JT, Chau R, Cascales P, Parrilla P. The approach of fused fissures with fissureless technique decreases the incidence of persistent air leak after lobectomy. Eur J Cardiothorac Surg. 2007;31:203–8.

    Article  Google Scholar 

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Acknowledgements

We thank members of the Division of Biostatistics at National Cancer Center for offering fruitful opinions and suggestions on the statistical method.

Funding

This work was supported in part by AMED Grant Number 19ck0106323h003 (SIW).

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Authors and Affiliations

  1. National Cancer Center Hospital, Department of Thoracic Surgery, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Masaya Yotsukura, Yu Okubo, Yukihiro Yoshida, Kazuo Nakagawa & Shun-ichi Watanabe

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  1. Masaya Yotsukura
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  2. Yu Okubo
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  3. Yukihiro Yoshida
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  4. Kazuo Nakagawa
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  5. Shun-ichi Watanabe
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Correspondence to Shun-ichi Watanabe.

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Yotsukura, M., Okubo, Y., Yoshida, Y. et al. Predictive factors and economic impact of prolonged air leak after pulmonary resection. Gen Thorac Cardiovasc Surg 70, 44–51 (2022). https://doi.org/10.1007/s11748-021-01677-3

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  • DOI: https://doi.org/10.1007/s11748-021-01677-3

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