Abstract
BackgroundResults of studies to predict prolonged air leak (PAL; air leak longer than 5 days) after pulmonary lobectomy have been inconsistent and are of limited use. We developed a new scale representing the amount of early postoperative air leak and determined its correlation with air leak duration and its potential as a predictor of PAL.MethodsWe grade postoperative air leak using a 5-grade scale. All 779 lobectomies from January 2005 to December 2009 with available medical records were reviewed retrospectively. We devised six ‘SUM’ variables using air leak grades in the initial 72 h postoperatively.ResultsExcluding unrecorded cases and postoperative broncho-pleural fistulas, there were 720 lobectomies. PAL occurred in 135 cases (18.8%). Correlation analyses showed each SUM variable highly correlated with air leak duration, and the SUM4to9, which was the sum of six consecutive values of air leak grades for every 8 h record on postoperative days 2 and 3, was proved to be the most powerful predictor of PAL; PAL could be predicted with 75.7% and 77.7% positive and negative predictive value, respectively, when SUM4to9 ≥ 16. When 4 predictors derived from multivariable logistic regression of perioperative variables were combined with SUM4to9, there was no significant increase in predictability compared with SUM4to9 alone.ConclusionsThis simple new method to predict PAL using SUM4to9 showed that the amount of early postoperative air leak is the most powerful predictor of PAL, therefore, grading air leak after pulmonary lobectomy is a useful method to predict PAL.
Highlights
Results of studies to predict prolonged air leak (PAL; air leak longer than 5 days) after pulmonary lobectomy have been inconsistent and are of limited use
‘SUM’ variables as predictors of PAL For quantitative comparison of early postoperative air leak, we devised 6 ‘SUM’ variables, based on which we evaluated the degree of air leak from P1 to P9 (Table 2)
Excluding the cases of 53 lacking graded records, 3 having 3 chest tubes, 2 postoperative broncho-pleural fistulas, and 1 followed by sequential operation in a situation where air leak after initial lobectomy had not ceased, a total of 720 consecutive lobectomies were included in this study
Summary
Results of studies to predict prolonged air leak (PAL; air leak longer than 5 days) after pulmonary lobectomy have been inconsistent and are of limited use. We developed a new scale representing the amount of early postoperative air leak and determined its correlation with air leak duration and its potential as a predictor of PAL. Many studies to elucidate the risk factors of PAL have been made to predict its occurrence [5,6,7,8,9,10], but the results were inconsistent and of limited use clinically. The authors developed a new quantitative scale to express the amount of early postoperative air leak to determine its correlation with air leak duration and possibility as a predictor of PAL. Rather than identifying the risk factors, we sought to determine whether observing the pattern of postoperative air leak might be a more direct and accurate way, based on a simple assumption: ‘the larger, the longer’.
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