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Original Articles: General Thoracic

Incidence and Risk Factors of Persistent Air Leak After Major Pulmonary Resection and Use of Chemical Pleurodesis

^a Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
^b Division of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts

Accepted for publication December 9, 2009.

^_* Address correspondence to Dr Lanuti, 55 Fruit St, Blake 1570, Boston, MA 01748 (Email: mlanuti{at}partners.org).

Presented at the Forty-fourth Annual Meeting of the Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: Persistent air leak (PAL; defined as air leak > 5 days) after major pulmonary resection is prevalent and associated with significant morbidity. This study examines an incompletely characterized treatment for the management of PAL, chemical pleurodesis.

Methods: A retrospective case-control study examining all isolated lobectomies and bilobectomies by thoracotomy was performed. The PALs (1997 to 2006) and controls (2002 to 2006) were identified from a prospective database. Incidence, risk factors, management, and outcome were defined.

Results: Over 9 years, 78 PALs were identified in 1,393 patients (5.6%). Controls consisted of 700 consecutive patients. Propensity score analysis matching case and controls showed no predictive risk factors for air leak using a logistic regression model. Univariate analysis demonstrated that female gender, smoking history, and forced vital capacity were predictive risk factors. Treatment of PAL consisted of observation (n = 33, 42.3%), pleurodesis (n = 41, 52.6%), Heimlich valve (n = 3, 3.8%), and reoperation (n = 1, 1.3%). Seventy-three patients (93.6%) required no further intervention. One patient required a muscle flap, one readmission for pneumothorax, and one empyema resulting in death. Sclerosis was successful in 40 of 41 patients (97.6%). Mean time to treatment was 8.4 ± 3.6 days, mean duration of air leak was 10.7 ± 4.5, and mean duration of air leak postsclerotherapy was 2.8 ± 2.2 days. Postoperative pneumonia occurred with increased frequency in PAL patients (6 of 45 [13.3%] vs 34 of 700 [4.9%], p = 0.014). PAL was associated with increased length of stay (14.2 vs 7.1 days, p < 0.001) and time with chest tube (11.5 vs 3.4 days, p < 0.001).

Conclusions: Air leaks remain an important cause of morbidity. Pleurodesis is an effective option in management of PAL after major pulmonary resection.

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