Abstract
Prolonged air leak (PAL), defined as air leak more than 5 days after lung resection, has been associated with various adverse outcomes. However, studies on intraoperative risk factors for PAL are not sufficient. We investigated whether the intraoperative ventilatory leak (VL) can predict PAL. A retrospective study of 1060 patients with chest tubes after lung resection was conducted. Tidal volume data were retrieved from the electronic anesthesia records. Ventilatory leak (%) was calculated as [(inspiratory tidal volume—expiratory tidal volume)/ inspiratory tidal volume × 100] and was measured after restart of two-lung ventilation. Cox proportional hazards regression analysis was performed using VL as a predictor, and PAL as the dependent outcome. The odds ratio of the VL was then adjusted by adding possible risk factors including patient characteristics, pulmonary function and surgical factors. The incidence of PAL was 18.7%. VL >9.5% was a significant predictor of PAL in univariable analysis. VL remained significant as a predictor of PAL (1.59, 95% CI, 1.37–1.85, P <0.001) after adjusting for 7 additional risk factors including male gender, age >60 years, body mass index <21.5 kg/m2, forced expiratory volume in 1 sec <80%, thoracotomy, major lung resection, and one-lung ventilation time >2.1 hours. C-statistic of the prediction model was 0.80 (95% CI, 0.77–0.82). In conclusion, VL was a quantitative measure of intraoperative air leakage and an independent predictor of postoperative PAL. Monitoring VL during lung resection may be uselful in recommending additional surgical repair or use of adjuncts and thus, help reduce postoperative PAL.
Highlights
Air leakage immediately after lung resection is common with an incidence of up to 60% and persists in 8% by postoperative day (POD) 4 [1,2]
Univariable Cox proportional hazards regression analysis showed that odds ratios of ventilatory leak (VL) to predict Prolonged air leak (PAL) were 1.05 per % increase of VL, or 1.89 when VL was greater than 9.5%
The VL remained a significant predictor of PAL with odds ratios of 1.03 as a continuous variable or 1.59 as a binary variable (VL >9.5%)
Summary
Air leakage immediately after lung resection is common with an incidence of up to 60% and persists in 8% by postoperative day (POD) 4 [1,2]. Prolonged air leak (PAL) is defined as air leakage lasting beyond 5 days after routine lung resection surgery [1,3]. Due to its association with adverse clinical outcomes and the challenges in postoperative management, prediction and prevention of PAL has been an important issue after lung resection [1,3,4]. Several intraoperative risk factors have been studied [3], but intraoperative air leak, despite its potential association with postoperative air leak, has not been thoroughly investigated. Performed intraoperative tests such as water-submersion test are less objective and can be biased [7,8]
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