Risk factors and outcomes of prolonged air leak after pulmonary resections

Pischik, Vadim; Maslak, Olga; Obornev, Aleksandr; Zinchenko, Evgenii; Коваленко, А. И.

doi:10.1007/s12055-019-00827-w

Cited by 9 publications

(6 citation statements)

References 19 publications

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“…The results of multivariate logistic regression showed that the type of resection and pleural adhesions were independent risk factors for extensive subcutaneous emphysema after pulmonary resection through VATS. Pischik et al reported that lobectomy and pleural adhesions were independent risk factors for prolonged air leak after pulmonary resection, which is consistent with the findings of the present study [ 27 ]. The occurrence of prolonged air leak increases the risk of subcutaneous emphysema, which explains why some of the risk factors for prolonged air leak and extensive subcutaneous emphysema are similar.…”

Section: Discussionsupporting

confidence: 93%

Risk factors for extensive subcutaneous emphysema after pulmonary resection by video-assisted thoracoscopic surgery: a case-control study.

Liu¹,

Feng²,

Liu³

2023

Videosurgery and Other Miniinvasive Techniques

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Introduction Extensive subcutaneous emphysema may lead to a significantly prolonged hospital stay, cosmetic problems, and even death without timely treatment. However, the risk factors for it have been poorly studied. Aim To clarify the prevalence and risk factors of extensive subcutaneous emphysema after pulmonary resection by video-assisted thoracoscopic surgery. Material and methods This is a retrospective matched case-control study. A sample of 86 cases and 258 matched controls was recruited from among 4339 patients admitted to the thoracic surgery department from October 2018 to October 2020 in a tertiary teaching hospital in China. Cases were patients who were diagnosed with extensive subcutaneous emphysema after pulmonary resection through video-assisted thoracoscopic surgery. Controls were matched in a ratio of 3 : 1 to the cases based on age and sex. Results In this study, the incidence rate of extensive subcutaneous emphysema was 2.05%, and approximately 75.58% of the cases occurred within 1 to 4 days postoperatively. In univariate analysis, patients with extensive subcutaneous emphysema were also likely to have a significant lower body mass index, worse pulmonary function, greater intraoperative blood loss, longer time of operation, history of lung surgery, wider scope of surgery, and more extensive pleural adhesion. The results of multivariate logistic regression showed that segmentectomy (OR = 3.130, 95% CI: 1.055–9.283, p = 0.040), lobectomy (OR = 4.487, 95% CI: 1.704–11.812, p = 0.002), and extensive pleural adhesion (OR = 4.514, 95% CI: 1.763–11.556, p = 0.002) were independent risk factors. Conclusions Segmentectomy, lobectomy, and extensive pleural adhesions were identified as independent risk factors for extensive subcutaneous emphysema after video-assisted thoracoscopic surgery.

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Section: Discussionsupporting

confidence: 93%

Risk factors for extensive subcutaneous emphysema after pulmonary resection by video-assisted thoracoscopic surgery: a case-control study.

Liu¹,

Feng²,

Liu³

2023

Videosurgery and Other Miniinvasive Techniques

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“…In 2022, Shintani et al analyzed data from the national clinical database in Japan ( N = 30,967) and concluded that male, older age, body mass index, and smoking are risk factors for PAL [ 11 ]. Pischik et al analyzed data from 319 patients who underwent pulmonary resection in their institution, and they identified male gender, smoking history, chronic obstruction lung disease, and preoperative hypoproteinemia as the main risk factors for PAL; however, they found no differences between open or thoracoscopic approaches [ 12 ]. However, in our results, we observed that the open approach was associated with PAL.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of fibrin sealant after pulmonary resection: a propensity score matching analysis

Yu¹,

Laohathai²

2022

kitp

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Introduction: Alveolar air leak is a common and troublesome complication after pulmonary resection because it can lead to longer hospital stay and chest tube drainage time. Aim: As fibrin sealants are useful in the management of alveolar air leaks, we evaluated their benefit in patients undergoing pulmonary resection. Material and methods: This retrospective study included patients who underwent pulmonary resection in our hospital between 2016 and 2021. We grouped patients on the basis of whether fibrin sealant was used during surgery and compared outcomes between those with (fibrin sealant group) and without (control group) sealant use after propensity score matching (1 : 1). Results: During the study period, 375 patients underwent pulmonary resection; of these, fibrin sealant was applied at the staple line in 107 patients (fibrin sealant group), whereas sealant was not used in 268 patients (control group). After propensity score matching (1 : 1), there were 95 patients in both groups. There were no differences between the two groups in duration of chest tube drainage (3 days vs. 3 days; p = 0.753) or length of hospital stay (5 days vs. 4 days; p = 0.499). However, the sealant group showed higher cost of hospitalization (USD 4,360 vs. 3,614; p < 0.001). Multivariate analysis for identifying risk factors of persistent air leak revealed that male sex and chronic obstructive pulmonary disease were associated. Conclusions: Our results indicate that application of fibrin sealant was not effective in reducing length of hospital stay, duration of chest drains or air leakage.

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“…According to previous studies, 34,35 the incidence of PAL is approximately 10%, which is more common in male patients and patients with preoperative pulmonary dysfunction (such as emphysema and COPD), lobotomy, pleural adhesion, low body mass index (BMI), right-side surgery, and underdeveloped fissures. [36][37][38][39][40][41] Of the nine patients with air leakage, six underwent surgery on the right side, of which three had underdeveloped fissures. Two patients had pleural adhesion that could lead to PAL.…”

Section: Discussionmentioning

confidence: 99%

Video-Assisted Thoracoscopic Day Surgery for Patients with Pulmonary Nodules: A Single-Center Clinical Experience of 200 Cases

Dong

Chang

et al. 2021

CMAR

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Background We reviewed our experience with 200 patients who underwent video-assisted thoracoscopic day surgery (VATDS) at the Day Surgery Center at West China Hospital to identify the safety and feasibility of VATDS and assess the value of novel management in patients with pulmonary nodules. Methods Between June 2019 and December 2020, 200 patients with pulmonary nodules underwent VATDS at the Day Surgery Center at West China Hospital. The medical records of these 200 patients were reviewed for age, sex, preoperative history, operative and pathological findings, amount of daily chest tube drainage, procedure method and duration, length of stay (LOS), visual analog scale (VAS), and postoperative pulmonary complications (PPCs). Results There were 45 male and 155 female patients with a median age of 43 years (range 18 to 58 years). A total of 158 (79.00%) patients were diagnosed with lung adenocarcinoma, 35 (17.50%) were diagnosed with chronic inflammation with fibrous hyperplasia, and seven (3.50%) were diagnosed with granulomatous inflammation with necrosis. The mean LOS of the 200 patients was 1.25±0.95 days, and 187 (93.50%) patients were discharged within 24 hours as planned. Thirteen patients were transferred to the thoracic surgery ward for further treatment because of PPCs. The median VAS was 3 points (range 1 to 7 points), and the rate of PPCs was 11.50%. Conclusion Two hundred patients underwent VATDS with an acceptable 24-hour discharge rate. However, selection of patients for VATDS is required, and the implementation of VATDS on a larger scale requires further discussion.

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Risk factors and outcomes of prolonged air leak after pulmonary resections

Cited by 9 publications

References 19 publications

Risk factors for extensive subcutaneous emphysema after pulmonary resection by video-assisted thoracoscopic surgery: a case-control study.

Risk factors for extensive subcutaneous emphysema after pulmonary resection by video-assisted thoracoscopic surgery: a case-control study.

Effectiveness of fibrin sealant after pulmonary resection: a propensity score matching analysis

Video-Assisted Thoracoscopic Day Surgery for Patients with Pulmonary Nodules: A Single-Center Clinical Experience of 200 Cases

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