Postoperative air leak grading is useful to predict prolonged air leak after pulmonary lobectomy
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RESEARCH ARTICLE
Open Access
Postoperative air leak grading is useful to predict prolonged air leak after pulmonary lobectomy Sang Gi Oh1, Yochun Jung1*†, Sanghoon Jheon2, Yunhee Choi3, Ju Sik Yun4, Kook Joo Na4 and Byoung Hee Ahn1*†
Abstract Background: 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. Methods: We 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. Results: Excluding 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. Conclusions: This 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. Keywords: Prolonged air leak, Lobectomy, Air leak grade
Background There is no clear consensus on the duration of prolonged air leak (PAL) [1], which is usually considered as lasting longer than 5 or 7 days postoperatively. Air leaking after pulmonary resection is natural, but its prolongation increases the risks of other pulmonary complications such as empyema [2] and unnecessarily lengthens hospital stay [3, 4]. Therefore, accurate prediction of PAL could enable early, selective postoperative * Correspondence: [email protected]; [email protected] † Equal contributors 1 Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42 Jebong-ro, 501-757 Dong-gu, Gwangju, South Korea Full list of author information is available at the end of the article
management to prevent PAL possible, which in turn help to reduce the complication risks and hospital costs. Many studies to elucidate the risk factors of PAL have been made to predict its occurrence [5–10], but the results were inconsistent and therefore, of limited use clinically. Thus, rather than identifying the risk factors, we sought to determine whether observing the pattern
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