Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 28;15(2):866-877.
doi: 10.21037/jtd-21-2011. Epub 2022 Jul 7.

Risk factors, complications and costs of prolonged air leak after video-assisted thoracoscopic surgery for primary lung cancer

Florian Ponholzer  1 , Caecilia Ng  1 , Herbert Maier  1 , Paolo Lucciarini  1 , Dietmar Öfner  1 , Florian Augustin  1
Affiliations

Risk factors, complications and costs of prolonged air leak after video-assisted thoracoscopic surgery for primary lung cancer

Florian Ponholzer et al. J Thorac Dis. .

Abstract

Background: Prolonged air leak (PAL) represents a common complication after lung resection. This study aims to analyze the risk factors for the development of a PAL, its impact on the postoperative outcome and to estimate additional treatment costs.

Methods: A single center database was queried for all patients scheduled for video-assisted thoracoscopic surgery for primary lung cancer. In total, 957 patients between 2009 and 2021 were analyzed. Exclusion criteria was pneumonectomy. Collected data included demographics and perioperative data (e.g., duration of surgery, postoperative infections, air leak duration etc.). PAL was defined as an air leak lasting for 5 days or longer. The PAL cohort included 103 patients, the non-PAL included 854 patients. Univariate analysis and binomial logistic regression were performed. Cost calculation was performed using available data from prior publications to estimate treatment costs.

Results: Male sex, chronic obstructive pulmonary disease (COPD) and low body mass index (BMI) showed to be risk factors for the development of postoperative PAL (P<0.001). Using these risk factors, a risk prediction score for PAL has been established. A subgroup analysis showed a significantly higher rate of sarcopenia in patients with PAL (P<0.001). The mean duration until removal of chest drains and length of stay (LOS) was significantly longer in the PAL cohort (14.2 vs. 4.4 days, P<0.001; 19.8 vs. 9.3 days, P<0.001). Also, the duration of the operation was longer in PAL patients (179.1 vs. 161.2 minutes, P=0.001). Patients with PAL had an elevated risk for postoperative infections [odds ratio (OR) 3.211, 31.1% vs. 12.3%, P<0.001]. As a result of a prolonged LOS, estimated treatment costs were significantly higher for PAL, ranging from 2,888.2 to 12,342.8 € depending on available cost bases compared to the non-PAL cohort, which ranged from 1,370.5 to 5,856.8 € (P<0.001).

Conclusions: PAL is a frequent complication that prolongs the LOS after thoracic surgery and, according to the literature, results in elevated readmission rates, leading to excess health care costs. Risk factors for PAL are well established. Preoperative treatment of sarcopenia and dismal nutritional status might alter the risk. As measures to prevent PAL are otherwise limited, guidelines for effective management of PAL need to be established.

Keywords: Prolonged air leak (PAL); complications; cost; risk factors.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-21-2011/coif). The special series “Prolonged Air Leak after Lung Surgery: Prediction, Prevention and Management” was sponsored by Bard Limited. Bard Limited has no interference on the contents of the special series. AF served as the unpaid Guest Editor of the series. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Modified PRISMA 2020 flow diagram. VATS, video-assisted thoracoscopic surgery.
Figure 2
Figure 2
Distribution of COPD GOLD stages between cohorts. COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Obstructive Lung Disease; PAL, prolonged air leak.
Figure 3
Figure 3
Duration until removal of the last chest drain and length of stay in days (non-PAL vs. PAL). PAL, prolonged air leak.
Figure 4
Figure 4
Cost estimations of length of stay using cost data from available literature.
See this image and copyright information in PMC

References

    1. Pompili C, Miserocchi G. Air leak after lung resection: pathophysiology and patients' implications. J Thorac Dis 2016;8:S46-54. 10.3978/j.issn.2072-1439.2015.11.08 - DOI - PMC - PubMed
    1. Brunelli A, Varela G, Refai M, et al. A scoring system to predict the risk of prolonged air leak after lobectomy. Ann Thorac Surg 2010;90:204-9. 10.1016/j.athoracsur.2010.02.054 - DOI - PubMed
    1. Cerfolio RJ, Bass CS, Pask AH, et al. Predictors and treatment of persistent air leaks. Ann Thorac Surg 2002;73:1727-30; discussion 1730-1. 10.1016/s0003-4975(02)03531-2 - DOI - PubMed
    1. Ziarnik E, Grogan EL. Postlobectomy Early Complications. Thorac Surg Clin 2015;25:355-64. 10.1016/j.thorsurg.2015.04.003 - DOI - PMC - PubMed
    1. Abolhoda A, Liu D, Brooks A, et al. Prolonged air leak following radical upper lobectomy: an analysis of incidence and possible risk factors. Chest 1998;113:1507-10. 10.1378/chest.113.6.1507 - DOI - PubMed