Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy☆

Varela, Gonzálo; Jiménez, Marcelo F.; Novoa, Nuria; Aranda, José Luis

doi:10.1016/j.ejcts.2004.11.005

Cited by 267 publications

(224 citation statements)

References 25 publications

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“…It is reported to cause increased stay and higher hospital costs. 16 In our study, the early application of CPAP was safe, and there was no report of prolonged air leak. This fact may reduce the concern of health professionals in recommending the early application of CPAP in the lung resection postoperative period.…”

Section: Discussionmentioning

confidence: 47%

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CPAP Increases 6-Minute Walk Distance After Lung Resection Surgery

et al. 2012

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BACKGROUND: The application of CPAP has been used to minimize postoperative pulmonary complications after lung resection surgery. The aim of this study was to quantify both the CPAP effects upon lung function and functional capacity in early postoperative lung resection, as well as to evaluate if CPAP prolongs air leak through the chest drain. METHODS: Thirty patients in the postoperative period of lung resection were allocated into 2 groups: an experimental group, consisting of 15 patients who underwent a 10 cm H 2 O CPAP, and a 15 patient control group, who performed breathing exercises. Arterial blood gas analysis, peak expiratory flow (PEF), respiratory muscle strength, spirometry, and 6-min walk test (6MWT) were assessed in the preoperative period, and repeated postoperatively on the first and on the seventh day (6MWT was repeated only on the seventh day). RESULTS: Significant increases in PEF, muscle strength, and FEV 1 between the first and seventh postoperative day were observed, both in the experimental and in the control group, whereas FVC and P aO 2 increased significantly between the first and seventh postoperative day only in the experimental group. The average loss in 6-min walk distance (6MWD) from preoperative to postoperative day 7 in the experimental group was significantly lower than in control group. When comparing the 2 groups, only 6MWD was statistically different (P < .001). There was no air leakage increase through the drain with the early use of CPAP. CONCLUSION: When compared to breathing exercises, CPAP increases the 6MWD in postoperative lung resection patients, without prolonging air leak through the chest drain.

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Section: Discussionmentioning

confidence: 47%

“…16 If no air leak was detected, the chest tubes were removed when the drainage was less than 200 mL/24 h.…”

Section: Study Protocolmentioning

confidence: 99%

CPAP Increases 6-Minute Walk Distance After Lung Resection Surgery

et al. 2012

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“…Furthermore, the impact on the healthcare system is significant as it prolongs hospital stay by 4 to 13 days [8] [9] [16] and as a result increases health-care costs [17].…”

Section: Introductionmentioning

confidence: 99%

Incidence Risk and Independent Predictors of Prolonged Air Leak in 269 Consecutive Pulmonary Resection Patients over Nine Months: A Single-Center Retrospective Cohort Study

Drewbrook¹,

Das²,

Mousadoust³

et al. 2016

OJTS

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Introduction: Prolonged air leak (PAL) is a common complication following pulmonary resection. It is associated with pneumonia, empyema, increased length of hospital stay and health-care costs. Intraoperative techniques have been developed to mitigate the risk of developing a PAL, but for their use to be efficient, identification of patients at risk for PAL is necessary. Aim: To determine the incidence of PAL following lobectomy and lesser pulmonary resections, risk factors for development of PALs, and the impact of PAL on hospital stay and readmission rates. Methods: The following variables were analyzed as PAL risk factors: patient characteristics of age, sex, body mass index (BMI), forced minute expiratory volume and capacity ratio (FEV1 and FEV1/FVC), diffusion capacity (DCLO), and transplant recipient status. Validated scoring systems included the Charlson Comorbidity Index (CCI), Medical Research Council (MRC) dyspnea score, and Eastern Cooperative Oncology Group (EGOC) score. Surgical factors included surgical technique, unplanned conversion from video-assisted thoracoscopic surgery (VATS) to thoracotomy, location and extent of resection, presence of adhesions, completeness of fissures, and method of fissure completion. Length of hospital stay and readmission rates were analyzed. Statistical tests performed on the data include univariate and multivariate logistic regression analyses. Results: Over the 9-month study duration there were 269 lung resections, of which 31 (11.52%) had an air leak lasting longer than 5 days. Mean length of stay in hospital was significantly longer in patients with PAL compared to the control group (13 vs 5 days, P < 0.001). Significant risk factors for PAL from multivariate 34planned conversion from video-assisted thoracoscopic surgery (VATS) to thoracotomy (P = 0.023). Conclusion: The incidence of PAL in our study population is similar to that found in previous studies. PAL prolongs hospital length of stay. Normal BMI, right upper lobectomy, and unplanned conversion from VATS to thoracotomy are risk factors for PAL.

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“…No universal consensus exist as to the exact duration of air leak which constitutes a prolonged air leak, but it is generally regarded to exist if it is present for more than 5 days(1-4) or 7 days(2, 5-7) after initial surgery. It is an important complication that results in increased length of stay (8)(9)(10)(11)(12)(13)(14)(15) and has been associated with other post-operative complications such as pneumonia (12,14,16), empyema (9,10,16) and ICU re-admission (12).…”

Section: Introductionmentioning

confidence: 99%