Intraoperative air leak measured after lobectomy is associated with postoperative duration of air leak

Brunelli, Alessandro; Salati, Michele; Pompili, Cecilia; Gentili, Paolo; Sabbatini, Armando

doi:10.1093/ejcts/ezx105

Cited by 30 publications

(25 citation statements)

References 24 publications

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“…Lastly, we found that initial air leaks were associated with both complication and reintervention rates. Therefore, careful dissection, early awareness of air leaks, and prevention strategies to decrease air leaks by all means, e.g., sealant use, in the operating room are important intraoperative factors that can reduce air leak-related complications [22].…”

Section: Discussionmentioning

confidence: 99%

Complications after Chest Tube Removal and Reinterventions in Patients with Digital Drainage Systems

Lee

Hsu

Huang

et al. 2019

JCM

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Introduction: Digital thoracic drainage systems are a new technology in minimally invasive thoracic surgery. However, the criteria for chest tube removal in digital thoracic drainage systems have never been evaluated. We aim to investigate the incidence and predictive factors of complications and reinterventions after drainage tube removal in patients with a digital drainage system. Method: Patients who received lung resection surgery and had their chest drainage tubes connected with a digital drainage system were retrospectively reviewed. Results: A total of 497 patients were monitored with digital drainage systems after lung resection surgery. A total of 175 (35.2%) patients had air leak-related complications after drainage tube removals, whereas 25 patients (5.0%) required reintervention. We identified that chest drainage duration of five days was an optimal cut-off value in predicting air leak-related complications and reinterventions. In multiple logistic regression analysis, previous chest surgery history; small size (16 Fr.) drainage tubes; the presence of initial air leaks, defined as air leaks recorded by the digital drainage system immediately after operation; and duration of chest drainage ≥5 days were independent factors of air leak-related complications, whereas the presence of initial air leaks and duration of chest drainage ≥5 days were independent predictive factors of reintervention after drainage tube removal. Conclusion: Air leak-related complications and reinterventions after drainage tube removals happened in 35.2% and 5.0% of patients with digital thoracic drainage systems. The management of chest drainage tubes in patients with predictive factors, i.e., the presence of initial air leaks and duration of chest drainage of more than five days, should be treated with caution.

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Section: Discussionmentioning

confidence: 99%

Complications after Chest Tube Removal and Reinterventions in Patients with Digital Drainage Systems

Lee

Hsu

Huang

et al. 2019

JCM

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“…4 The greater the degree of intraoperative air leak, the higher the risk of developing postoperative prolonged air leak. 3 Intraoperative air leak can be of bronchial or alveolar origin. 1 Bronchial leak should be controlled surgically with either sutures or staples.…”

Section: Discussionmentioning

confidence: 99%

“…2 Studies have shown that patients with more intraoperative air leaks are at higher risk of developing prolonged postoperative air leak. 3 Intraoperative air leaks can be measured collectively by ventilator parameters (the difference between inspiratory and expiratory tidal volume), 3 or by the normal saline test that identifies the leakage points and the degree of leakage at each point. 10 Traditional methods (suturing and stapling) can be used to control intraoperative air leak, but with an alveolar air leak, these methods may cause more tears in the lung parenchyma.…”

Section: Introductionmentioning

confidence: 99%

Using tissue glues for decreasing alveolar air leak in thoracic surgery

Allama

Elaziz

2019

Asian Cardiovasc Thorac Ann

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Background Prolonged air leak is one of the most annoying complications after pulmonary surgery. Studies have shown that patients with more intraoperative air leaks are at higher risk of developing prolonged postoperative air leak. Various types of sealants have been used effectively for decreasing intraoperative alveolar air leak. We decided to compare 3 sealants to determine which was best. Methods This was a prospective nonrandomized study that included 120 patients undergoing pulmonary surgical procedures associated with intraoperative air leak. They were divided into 4 equal groups. In the first group, no sealant was used. Glubran 2 sealant was used in the second group, BioGlue in the third, and TachoSil in the fourth. Results Preoperative and intraoperative data showed no significant differences among groups, except age which was significantly older in the BioGlue group. Air leak duration and tube duration were significantly shorter in the sealant groups, separately and collectively. No significant difference was found among groups regarding total tube drainage. Also, no significant difference was found between the no-sealant and sealant groups collectively regarding the incidence of postoperative complications, but the BioGlue group had a significantly lower incidence of postoperative complications compared to the no-sealant group. Postoperative hospital stay was significantly shorter in the sealant groups, separately and collectively. Conclusion Our results support the use of sealants for decreasing alveolar air leak. They were easily used in a short time with no significant superiority of one sealant over the others, except for a lower incidence of postoperative complications with BioGlue.

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“…The second way could be the adoption of a meticulous surgical technique as appropriate tissue manipulation and retraction, mobilization of all intrapleural adhesions, division of the inferior pulmonary ligament, routine pre-compression of staple lines, fissureless/fissurelast technique, and select use of surgical sealant (9,10). Finally, an objective intraoperative measurement of intraoperative air leak (IAL) is of importance (11,12).…”

Section: Introductionmentioning

confidence: 99%

Prolonged air leak after video-assisted thoracic anatomical pulmonary resections: a clinical predicting model based on data from the Italian VATS group registry, a machine learning approach

Divisi¹,

Pipitone²,

Perkmann³

et al. 2023

J Thorac Dis

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Background: Prolonged air leak (PAL) is a frequent complication after lung resection surgery and has a high clinical and economic impact. A useful risk predictor model can help recognize those patients who might benefit from additional preventive procedures. Currently, no risk model has sufficient discriminatory capacity to be used in common clinical practice. The aim of this study is to identify predictive risk factors for PAL after video-assisted thoracoscopic surgery (VATS) anatomical resections in the Italian VATS group database and to evaluate their clinical and statistical performance. Methods:We processed data collected in the second edition of the Italian VATS group registry. It includes patients that underwent a thoracoscopic anatomical resection for benign or malignant diseases, between November 2015 and December 2020. We used recursive feature elimination (RFE), using a backward selection process, to find the optimal combination of predictors. The study population was randomly split based on the outcome into a derivation (80%) and an internal validation cohort (20%). Discrimination of the model was measured using the area under the curve, or C-statistic. Calibration was displayed using a calibration plot and was measured using Emax and Eavg, the maximum and the average difference in predicted versus loess calibrated probabilities.Results: A cohort of 6,236 patients was eligible for the study after application of the exclusion criteria.Five-day PAL rate in this patient cohort was 11.3%. For the construction of our predictive model, we used both preoperative and intraoperative variables, with a total of 320 variables. The presence of variables with missing values greater than 5% led to 120 remaining predictors. RFE algorithm recommended 8 features for the model that are relevant in predicting the target variable. Conclusions:We confirmed significant prognostic risk factors for the prediction of PAL: decreased DLCO/VA ratio, longer duration of surgery, male sex, the need for adhesiolysis, COPD, and right side. We identified middle lobe resections and ground glass opacity as protective factors. After internal validation, a C statistic of 0.63 was revealed, which is too low to generate a reliable score in clinical practice.

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Intraoperative air leak measured after lobectomy is associated with postoperative duration of air leak

Cited by 30 publications

References 24 publications

Complications after Chest Tube Removal and Reinterventions in Patients with Digital Drainage Systems

Complications after Chest Tube Removal and Reinterventions in Patients with Digital Drainage Systems

Using tissue glues for decreasing alveolar air leak in thoracic surgery

Prolonged air leak after video-assisted thoracic anatomical pulmonary resections: a clinical predicting model based on data from the Italian VATS group registry, a machine learning approach

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