Characterization and prediction of prolonged air leak after pulmonary resection: a nationwide study setting up the index of prolonged air leak

Ann Thorac Surg. 2011 Sep;92(3):1062-8; discussion 1068. doi: 10.1016/j.athoracsur.2011.04.033.

Abstract

Background: The objective of this study was to better characterize prolonged air leak (PAL), defined as an air leak longer than 7 days, and to develop and validate a predictive model of this complication after pulmonary resection.

Methods: All lung resections entered in Epithor, the French national thoracic database (French Society of Thoracic and Cardiovascular Surgery), were analyzed. Data collected between 2004 and 2008 (n=24,113) were used to build the model using backward stepwise variable selection, and the 2009 data (n=6,813) were used for external validation. The primary outcome was PAL. Results of the predictive model were used to propose a score: the index of PAL (IPAL).

Results: Prevalence of PAL after pulmonary resection was 6.9% (n=1,655) in the development data set. In the final model, 9 variables were selected: gender, body mass index, dyspnea score, presence of pleural adhesions, lobectomy or segmentectomy, bilobectomy, bulla resection, pulmonary volume reduction, and location on upper lobe. In the development data set, the C-index was 0.71 (95% confidence interval [CI], 0.70 to 0.72). At external validation, the C-index was 0.69 (95% CI, 0.66 to 0.72) and the calibration slope (ie, the agreement between observed outcomes and predictions) was 0.874 (<1). A score chart based on these analyses has been proposed. The formula to calculate the IPAL is the following: gender (F=0; M=4)-(body mass index-24)+2×dyspnea score+pleural adhesion (no=0; yes=4)+pulmonary resection (wedge=0; lobectomy or segmentectomy=7; bilobectomy=11; bulla resection=2; volume reduction=14)+location (lower or middle lobe=0; upper=4).

Conclusions: Surgeons can easily use the well-validated model to determine intraoperative preventive measures of PAL.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Air
  • Anastomosis, Surgical / adverse effects
  • Anastomosis, Surgical / methods
  • Anastomotic Leak / diagnosis*
  • Anastomotic Leak / epidemiology
  • Anastomotic Leak / etiology
  • Female
  • Follow-Up Studies
  • France / epidemiology
  • Humans
  • Incidence
  • Lung Diseases / surgery*
  • Male
  • Middle Aged
  • Pneumonectomy / adverse effects*
  • Pneumonectomy / methods
  • Predictive Value of Tests
  • Prevalence
  • Prognosis
  • Retrospective Studies
  • Risk Assessment / methods*
  • Severity of Illness Index
  • Survival Rate / trends
  • Time Factors
  • Young Adult