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Risk factors and outcomes of prolonged air leak after pulmonary resections

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Purpose

Prolonged air leak (PAL) is a challenging complication in thoracic surgery. The aim of this study was to analyze the incidence, risk factors, and outcomes of PAL.

Methods

We retrospectively analyzed 319 patients treated in a single center submitted to lobectomy, bilobectomy, segmentectomy, and wedge resections from January 2012 until August 2015. PAL was defined as air leak lasting more than 7 days after surgery.

Results

The incidence of PAL was 14.7%. Bronchial obstruction (p < 0.05), low body mass index (BMI, p < 0.05), and hypoproteinemia (p < 0.001) were identified as independent preoperative risk factors of PAL. Intraoperative risk factors were lob- (p < 0.01) and bilobectomies (p < 0.05), pleural adhesions (p < 0.001), and length of stapler line (p < 0.001). Among the postoperative risk factors, we identified the use of active drainage (p < 0.01), the presence of subcutaneous emphysema (p < 0.001), massive air leak on the first postoperative day (POD 1, p < 0.001), and an incomplete re-expansion of the lung (p < 0.001). PAL was not associated with more complications in the postoperative period. One patient required reoperation due to a massive air leak. Twenty-six patients were discharged with a Heimlich valve with no complications and no need for re-admission.

Conclusions

Bronchial obstruction, low BMI, hypoproteinemia, lob- and bilobectomies, pleural adhesions, length of stapler line, use of active drainage, the presence of subcutaneous emphysema, massive air leak on POD 1, and incomplete re-expansion of the lung were identified as independent risk factors of PAL. It had no influence on outcomes.

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Authors and Affiliations

  1. Clinical Hospital 122, Kultury pr. 4, Saint Petersburg, Russia

    Vadim Grigoryevich Pischik, Aleksandr Dmitrievich Obornev, Eugeniy Igorevich Zinchenko & Aleksandr Igorevich Kovalenko

  2. Faculty of Medicine, Saint Petersburg State University, Universitetskaya emb. 7/9, Saint Petersburg, Russia

    Vadim Grigoryevich Pischik, Olga Sergeevna Maslak & Aleksandr Igorevich Kovalenko

Authors
  1. Vadim Grigoryevich Pischik
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  2. Olga Sergeevna Maslak
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  3. Aleksandr Dmitrievich Obornev
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  4. Eugeniy Igorevich Zinchenko
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  5. Aleksandr Igorevich Kovalenko
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Correspondence to Olga Sergeevna Maslak.

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The authors declare that they have no conflict of interest.

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent was obtained from all individual participants included in the study.

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Pischik, V.G., Maslak, O.S., Obornev, A.D. et al. Risk factors and outcomes of prolonged air leak after pulmonary resections. Indian J Thorac Cardiovasc Surg 35, 564–568 (2019). https://doi.org/10.1007/s12055-019-00827-w

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  • DOI: https://doi.org/10.1007/s12055-019-00827-w

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