Quantifying the incidence and impact of postoperative prolonged alveolar air leak after pulmonary resection

Abstract

Objective: Prolonged alveolar air leak (PAAL) is a frequent occurrence after lobectomy or lesser resections. The resulting complications and their impact are not well understood. Our aims are to prospectively determine the incidence and severity of PAAL after pulmonary resection using the Thoracic Morbidity & Mortality classification system and to identify risk factors.

Methods: A prospective collection of Thoracic Morbidity & Mortality data was performed for all consecutive pulmonary resections (n = 380; January 2008 to April 2010). Demographics, comorbidities, and preoperative cardiopulmonary assessment were retrospectively identified. The incidence and severity (grades I-V) of burden from PAAL were quantified using the Ottawa Thoracic Morbidity & Mortality system. Risk factors for PAAL and severe PAAL (defined as leading to major intervention, organ failure, or death) were sought with univariate and multivariate analyses.

Results: The incidences of PAAL and severe PAAL were 18% and 4.8%, respectively. PAAL prolonged the median hospital stay by 4 days. The majority of complications associated with PAAL were limited to pulmonary and pleural categories (90%). Significant predictors of PAAL from multivariate analysis include severe radiologic emphysema (odds ratio [OR], 2.8; confidence interval [CI], 1.2-6.2), histopathologic emphysema (OR, 1.9; CI, 1.1-3.6), percentage of predicted value for forced expiratory volume in 1 second less than 80% (OR, 1.9; CI, 1.1-3.3), and lobectomy (OR, 4.9; CI, 1.-14.1). Risk factors for severe PAAL include radiologic emphysema, percentage of predicted value for forced expiratory volume in 1 second less than 80%, forced expiratory volume in 1 second/forced vital capacity ratio less than 70%, and intraoperative difficulties (P < .05).

Conclusions: PAAL leads to longer hospital stays, and approximately 4.8% of patients undergoing pulmonary resection experience PAAL that necessitates placement of additional chest drains, bronchoscopy, reoperation, or life support. Further study is required to assess the cost-effectiveness of measures to reduce PAAL.