Risk Factors for Prolonged Air Leakage after Uniportal Anatomical Segmentectomy

Abstract

Abstract Background As the population ages and comorbidities increase, minimal invasive anatomical segmentectomies are increasingly being performed. Complications are to be considered in this vulnerable population. Aims Our aim was to investigate the incidence and risk factors for prolonged air leak in patients undergoing minimally invasive single-port pulmonary segmentectomy at our institution. Methods Retrospective analysis of all patients undergoing uniportal segmentectomy in our department from March 2015 to August 2023. Prolonged air leak (PAL) was defined as an air leak that lasted longer than 5 days. Results 575 segmentectomies were performed using uniportal video-assisted thoracoscopic surgery (uVATS). 374 complex segmentectomies (65.0%) and 405 (70.4%) single segmentectomies were performed. Prolonged air leak occurred in 88 patients (15.3%). Length of stay and duration of drainage were 8.6 (±4.86) and 10.6 (±8.12) days in the PAL subgroup, whereas they wer 3.6 (±2.25) and 2.0 (±1.3) days in the non-PAL group, both statistically significant. Patients with COPD GOLD II/III were significantly more common in the PAL group. Using machine learning, two models were developed that predicted the occurrence of PAL with an accuracy of 70 %. The first model detected the following parameters as significant: removal of segment 2 or 8, diabetes, inhalers, squamous cell carcinoma. The second model recognized DLCO (%), pack-years, FEV1 (%) and operation time as parameters. Furthermore, we used recursive partitioning to develop a decision tree that stratified PAL risk by answering 1-3 yes/no questions. Patients with >28 pack-years and DLCO < 71% had a 77% probability of developing prolonged air leak. Conclusion Severe COPD, low DLCO and FEV1, increased pack-years, inhalers, diabetes, and segment 2 or 8 surgery were identified as risk factors for prolonged air leak. These findings may help in the planning of surgery and the use of sealants at the end of surgery in high-risk patients.