Quantifying the incidence and impact of postoperative prolonged alveolar air leak after pulmonary resection

Liang, Shuyin; Ivanovic, Jelena; Gilbert, Sébastien; Maziak, Donna E.; Shamji, Farid M.; Sundaresan, R. Sudhir; Seely, Andrew J. E.

doi:10.1016/j.jtcvs.2012.08.044

Cited by 69 publications

(73 citation statements)

References 19 publications

(37 reference statements)

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“…Previous studies have found that the impact of PAL 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]. The mean LOS for patients with PAL in our study was significantly longer at 12.6 days compared to 5.0 days for patients in the control group (P < 0.0001).…”

Section: Discussionmentioning

confidence: 44%

“…The definition of a prolonged air leak (PAL) varies in the literature, but the currently accepted definition is an air leak lasting 5 or more days postoperatively [2] which is the average length of stay (LOS) in hospital following lobectomy [3]. In previous studies, PAL has been found to occur in up to 26% of patients following lobectomy and lesser pulmonary resections [4] [5] [6] [7] [8].…”

Section: Introductionmentioning

confidence: 99%

“…Additional risk factors that have been described include reduced diffusing capacity [9] [12], upper resections or bilobectomy [5], pleural adhesions [5] [12], relatively lower BMI [13] [14], increased dyspnea score [14], concurrent pneumothorax [9] [10], lobectomy [10] [14], preoperative inhaled or systemic steroid use [10] [15], radiologic findings of severe emphysema [8], and histopathologic findings of emphysema [8].…”

Section: Introductionmentioning

confidence: 99%

“…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%

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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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Section: Discussionmentioning

confidence: 44%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…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%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

show abstract

“…Risk factors for a PAL include: chronic obstructive pulmonary disease (COPD), bilobectomy, upper lobectomy, diffusing capacity of carbon monoxide (DLCO) less than 80% predicted and steroid use (3,8). Postoperative air leaks are not just an annoyance that prolongs hospitalization; they can be a surrogate marker for increased morbidity and complications like postoperative atrial fibrillation and pneumonia (9).…”

Section: Apical Spaces and Pals After A Pulmonary Resectionmentioning

confidence: 99%

Chest drainage systems and management of air leaks after a pulmonary resection

Baringer¹,

Talbert²

2017

J. Thorac. Dis.

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Air leaks after a pulmonary resection continue to be the most common postoperative complication. The presence of an air leak occurs in approximately 30-50% of patients immediately after surgery. Prolonged air leaks (PALs) predict an increased hospital length of stay, additional chest tube days and increased pain. The two types of systems used after surgery are digital and traditional chest drainage devices. Eighteen articles from four databases were evaluated for this analysis in chest drainage systems and managing air leaks after thoracic surgery. The digital and traditional drainage devices were evaluated.PALs were examined with interobserver variability of air leak assessment and differences in the two systems were addressed. The research gaps in the digital system are examining what flow thresholds should be used to safely remove a chest tube after surgery and for what length of time. In future research, the next step is standardizing chest tube management to decrease individual surgeon preference. Treatment of air leaks implementing scientific data instead of personal preference and opinion by a surgeon can lead to earlier chest tube removal, decreased morbidity and a shorter hospital stay.

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Sound‐guided assessment and localization of pulmonary air leak

Pinezich

Mir

Reimer

et al. 2022

Bioengineering & Transla Med

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Pulmonary air leak is the most common complication of lung surgery, with air leaks that persist longer than 5 days representing a major source of post‐surgery morbidity. Clinical management of air leaks is challenging due to limited methods to precisely locate and assess leaks. Here, we present a sound‐guided methodology that enables rapid quantitative assessment and precise localization of air leaks by analyzing the distinct sounds generated as the air escapes through defective lung tissue. Air leaks often present after lung surgery due to loss of tissue integrity at or near a staple line. Accordingly, we investigated air leak sounds from a focal pleural defect in a rat model and from a staple line failure in a clinically relevant swine model to demonstrate the high sensitivity and translational potential of this approach. In rat and swine models of free‐flowing air leak under positive pressure ventilation with intrapleural microphone 1 cm from the lung surface, we identified that: (a) pulmonary air leaks generate sounds that contain distinct harmonic series, (b) acoustic characteristics of air leak sounds can be used to classify leak severity, and (c) precise location of the air leak can be determined with high resolution (within 1 cm) by mapping the sound loudness level across the lung surface. Our findings suggest that sound‐guided assessment and localization of pulmonary air leaks could serve as a diagnostic tool to inform air leak detection and treatment strategies during video‐assisted thoracoscopic surgery (VATS) or thoracotomy procedures.

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Quantifying the incidence and impact of postoperative prolonged alveolar air leak after pulmonary resection

Cited by 69 publications

References 19 publications

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

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

Chest drainage systems and management of air leaks after a pulmonary resection

Sound‐guided assessment and localization of pulmonary air leak

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