Risk factors and outcomes of prolonged air leak

Abstract

Introduction: Prolonged air leak (PAL) is one of the main complications of the postoperative period in modern thoracic surgery. Although many studies have been set worldwide and a lot of possible risk factors have been examined, this issue remains controversial.

Aims and Objectives: The aim of this study was to reveal the incidence, risk factors of PAL and to analyze its outcomes and safety of outpatient management.

Methods: We retrospectively analyzed 319 consecutive patients submitted to lobectomy, bilobectomy, segmentectomy, and wedge resections from January 2012 till August 2015. PAL was defined as air leak lasting more than 7 days after surgery.

Results: The incidence of a prolonged air leak was 14,7%. Bronchial obstruction (p<0,05), low body mass index (BMI) (p<0,05) and hypoproteinemia (p<0,001) were identified as preoperative risk factors of PAL. Intraoperative risk factors were lob- (p<0,01) and bilobectomy (p<0,05), pleural adhesions (p<0,001) and length of stapler line (p<0,001). Among postoperative risk factors, we identified the use of suction drainage (p<0,01), the presence of subcutaneous emphysema (p<0,001) and incomplete re-expansion of the lung (p<0,001). There were no complications of PAL. One patient required reoperation. 26 patients were discharged with a Heimlich valve with no complications and no need for re-admission.

Conclusions: Bronchial obstruction, low BMI, hypoproteinemia, lob- and bilobectomy, pleural adhesions, length of stapler line, use of suction drainage, the presence of subcutaneous emphysema and incomplete re-expansion of the lung were identified as risk factors of PAL. It had no influence on outcomes, except prolongation of hospital stay that can be effectively solved by discharge with Heimlich valve.