A nomogram for preoperative prediction of prolonged air leak after pulmonary malignancy resection

Abstract

Background: Prolonged air leak (PAL) is one of the most common postoperative complications after lung surgery. This study aimed to identify risk factors of PAL after lung resection and develop a preoperative predictive model to estimate its risk for individual patients.Methods: Patients with pulmonary malignancies or metastasis who underwent pulmonary resection between January 2014 and January 2018 were included. PAL was defined as an air leak more than 5 days after surgery, risk factors were analyzed. Forward stepwise multivariable logistic regression analysis was performed to identify independent risk factors, and a derived nomogram was built. Data from February 2018 to September 2018 were collected for internal validation.Results: A total of 1,511 patients who met study criteria were enrolled in this study. The overall incidence of PAL was 9.07% (137/1,511). Age, percent forced expiratory volume in 1 second, surgical type, surgical approach and smoking history were included in the final model. A nomogram was developed according to the multivariable logistic regression results. The C-index of the predictive model was 0.70, and the internal validation value was 0.77. The goodness-of-fit test was non-significant for model development and internal validation. Conclusions:The predictive model and derived nomogram achieved satisfied preoperative prediction of PAL. Using this nomogram, the risk for an individual patient can be estimated, and preventive measures can be applied to high-risk patients.

Perioperative outcomes of robotic‐assisted versus video‐assisted thoracoscopic lobectomy: A propensity score matched analysis

“…Chylothorax was diagnosed by clinicians based on relevant laboratory tests 26 including pleural effusion triglyceride concentration >110 mg/dL (1.24 mmol/L), exudative effusion with lymphocytes predominating (>70% of total nucleated cells), or pleural effusion Sudan III staining positive, and so forth. Patients with air leak > days after surgery were defined as having prolonged air leak 24,27–30 …”

“…Patients with air leak > days after surgery were defined as having prolonged air leak. 24,[27][28][29][30] Surgical approach VATS and RATS groups were the same in terms of identical positioning, anesthesia and lobectomy procedures during surgery except for the surgical approach.…”

Intraoperative prevention and conservative management of postoperative prolonged air leak after lung resection: a systematic review

“…Most of literature, however, is focused on the potential prognostic factors leading to PAL, such as age, COPD, smoking history, pleural adhesions and upper lobe resections (6)(7)(8) rather than on its management which, in fact, has never been systematically analyzed. The main reason is the high number of measures described to prevent or solve the intra-or post-operative PAL, that each Center would rather adopt according to its availability and surgeon's expertise and confidence (9); therefore, despite the high incidence of post-operative PAL, specific guidelines are lacking.…”

Construction and validation of a nomogram for predicting prolonged air leak after minimally invasive pulmonary resection

“…The majority of the previously reported models were based on the data from European and the USA, which might make it not applicable for Asian populations [ 12 – 14 , 16 – 18 ]. In addition, the differences in PAL definitions and patient selection criteria made the results of these studies less credible [ 12 – 15 , 18 ]. Moreover, in the era of minimally invasive pulmonary resection as the dominant surgical procedure, traditional thoracotomy is rarely performed, and thus the clinical utility of previous models incorporating thoracotomy as a risk factor would be greatly reduced.…”