Advertisement

Prediction of prolonged air leak after lung resection using continuous log data of flow by digital drainage system

  • Masaki Goto
  • Keiju AokageEmail author
  • Keigo Sekihara
  • Tomohiro Miyoshi
  • Kenta Tane
  • Kohei Yokoi
  • Masahiro Tsuboi
Original Article
  • 10 Downloads

Abstract

Purpose

The aim of this study was to extract predictive factors of prolonged air leak (PAL) including air flow data as objective parameter by digital drainage system (DDS).

Methods

The 372 patients who underwent lung resection and had continuous log data of air flow by DDS were reviewed. PAL was defined as the air leak which was exceeding 20 ml/min and lasting 5 days or more. The 69 patients (18.5%) showed air leak and were divided into PAL group (n = 21) and non-PAL group (n = 48). The average flow per hour was calculated at 0, 12, and 24 postoperative hours (POH) and the residual ratio of flow at 12, 24, and 36 POH to that at the time after surgery was analyzed with clinical factors. Area under the receiver-operating characteristic curve (ROC-AUC) was calculated to determine optimal cut-off value of PAL predictors.

Results

ROC-AUC for flow at 36 POH was 0.88. Sensitivity and specificity were 0.91 and 0.73 when cut-off value was set at 20 mL/min at 36 POH. ROC-AUC for residual ratio at 36 POH was 0.82. Sensitivity and specificity were 0.81 and 0.79 when cut-off value of residual ratio was set at 0.20.

Conclusions

The air flow and the residual ratio measured by DDS will be useful predictors of postoperative PAL after lung resection.

Keywords

Prolonged air leak Digital drainage system Perioperative management 

Notes

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Supplementary material

11748_2019_1073_MOESM1_ESM.pdf (144 kb)
Supplementary material 1 (PDF 144 KB)
11748_2019_1073_MOESM2_ESM.pdf (121 kb)
Supplementary material 2 (PDF 121 KB)

References

  1. 1.
    Cerfolio RJ, Bass CS, Pask AH, Katholi CR. Predictors and treatment of persistent air leaks. Ann Thorac Surg. 2002;73:1727–30. (discussion 30–1).CrossRefGoogle Scholar
  2. 2.
    Brunelli A, Varela G, Refai M, Jimenez MF, Pompili C, Sabbatini A, et al. A scoring system to predict the risk of prolonged air leak after lobectomy. Ann Thorac Surg. 2010;90:204–9.CrossRefGoogle Scholar
  3. 3.
    Orsini B, Baste JM, Gossot D, Berthet JP, Assouad J, Dahan M, et al. Index of prolonged air leak score validation in case of video-assisted thoracoscopic surgery anatomical lung resection: Results of a nationwide study based on the French national thoracic database, epithor. Eur J Cardiothorac Surg. 2015;48:608–11.CrossRefGoogle Scholar
  4. 4.
    Attaar A, Winger DG, Luketich JD, Schuchert MJ, Sarkaria IS, Christie NA, et al. A clinical prediction model for prolonged air leak after pulmonary resection. J Thorac Cardiovasc Surg. 2016.  https://doi.org/10.1016/j.jtcvs.2016.10.003.Google Scholar
  5. 5.
    Varela G, Jimenez MF, Novoa NM, Aranda JL. Postoperative chest tube management: Measuring air leak using an electronic device decreases variability in the clinical practice. Eur J Cardiothorac Surg. 2009;35:28–31.CrossRefGoogle Scholar
  6. 6.
    Bertolaccini L, Rizzardi G, Filice MJ, Terzi A. ‘Six sigma approach’—an objective strategy in digital assessment of postoperative air leaks: a prospective randomised study. Eur J Cardiothorac Surg. 2011;39:e128-32.CrossRefGoogle Scholar
  7. 7.
    Petrella F, Rizzo S, Radice D, Borri A, Galetta D, Gasparri R, et al. Predicting prolonged air leak after standard pulmonary lobectomy: computed tomography assessment and risk factors stratification. Surgeon. 2011;9:72–7.CrossRefGoogle Scholar
  8. 8.
    Pompili C, Brunelli A, Salati M, Refai M, Sabbatini A. Impact of the learning curve in the use of a novel electronic chest drainage system after pulmonary lobectomy: A case-matched analysis on the duration of chest tube usage. Interact Cardiovasc Thorac Surg. 2011;13:490–3. (discussion 93).CrossRefGoogle Scholar
  9. 9.
    Brunelli A, Salati M, Pompili C, Refai M, Sabbatini A. Regulated tailored suction vs regulated seal: a prospective randomized trial on air leak duration. Eur J Cardiothorac Surg. 2013;43:899–904.CrossRefGoogle Scholar
  10. 10.
    Miller DL, Helms GA, Mayfield WR. Digital drainage system reduces hospitalization after video-assisted thoracoscopic surgery lung resection. Ann Thorac Surg. 2016;102:955–61.CrossRefGoogle Scholar
  11. 11.
    Shoji F, Takamori S, Akamine T, Toyokawa G, Morodomi Y, Okamoto T, et al. Clinical evaluation and outcomes of digital chest drainage after lung resection. Ann Thorac Cardiovasc Surg 2016;22:354–58. (advpub).CrossRefGoogle Scholar
  12. 12.
    Attaar A, Winger DG, Luketich JD, Schuchert MJ, Sarkaria IS, Christie NA, et al. A clinical prediction model for prolonged air leak after pulmonary resection. J Thorac Cardiovasc Surg. 2017;153:690–99 e2.CrossRefGoogle Scholar
  13. 13.
    Rivera C, Bernard A, Falcoz PE, Thomas P, Schmidt A, Benard S, et al. 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;92:1062–8. (discussion 68).CrossRefGoogle Scholar
  14. 14.
    Brunelli A, Cassivi SD, Salati M, Fibla J, Pompili C, Halgren LA, et al. Digital measurements of air leak flow and intrapleural pressures in the immediate postoperative period predict risk of prolonged air leak after pulmonary lobectomy. Eur J Cardiothorac Surg. 2011;39:584–8.CrossRefGoogle Scholar
  15. 15.
    Bille A, Borasio P, Gisabella M, Errico L, Lausi P, Lisi E, et al. Air leaks following pulmonary resection for malignancy: risk factors, qualitative and quantitative analysis. Interact Cardiovasc Thorac Surg. 2011;13:11–5.CrossRefGoogle Scholar
  16. 16.
    Takamochi K, Imashimizu K, Fukui M, Maeyashiki T, Suzuki M, Ueda T, et al. Utility of objective chest tube management after pulmonary resection using a digital drainage system. Ann Thorac Surg. 2017;104:275–83.CrossRefGoogle Scholar
  17. 17.
    Pompili C, Detterbeck F, Papagiannopoulos K, Sihoe A, Vachlas K, Maxfield MW, et al. Multicenter international randomized comparison of objective and subjective outcomes between electronic and traditional chest drainage systems. Ann Thorac Surg. 2014;98:490–6. (discussion 96–7).CrossRefGoogle Scholar
  18. 18.
    Ciccone AM, Meyers BF, Guthrie TJ, Davis GE, Yusen RD, Lefrak SS, et al. Long-term outcome of bilateral lung volume reduction in 250 consecutive patients with emphysema. J Thorac Cardiovasc Surg. 2003;125:513–25.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  • Masaki Goto
    • 1
    • 2
  • Keiju Aokage
    • 1
    Email author
  • Keigo Sekihara
    • 1
  • Tomohiro Miyoshi
    • 1
  • Kenta Tane
    • 1
  • Kohei Yokoi
    • 2
  • Masahiro Tsuboi
    • 1
  1. 1.Department of Thoracic SurgeryNational Cancer Center Hospital EastKashiwaJapan
  2. 2.Department of Thoracic SurgeryNagoya University Graduate School of MedicineNagoyaJapan

Personalised recommendations