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Original Articles: General Thoracic

A Scoring System to Predict the Risk of Prolonged Air Leak After Lobectomy

^a Division of Thoracic Surgery, Ospedali Riuniti, Ancona, Italy
^b Division of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain

Accepted for publication February 3, 2010.

^_* Address correspondence to Dr Brunelli, Division of Thoracic Surgery, Ospedali Riuniti, Via Conca 1, Ancona, IT60020, Italy (Email: brunellialex{at}gmail.com).

Presented at the Forty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 25–27, 2010.

Background: Prolonged air leak (PAL) remains a frequent complication after lung resection. Perioperative preventative strategies have been tested, but their efficacy is often difficult to interpret due to heterogeneous inclusion criteria. The objective of this study was to develop and validate a practical score to stratify the risk of PAL after lobectomy.

Methods: Six hundred fifty-eight consecutive patients were submitted to pulmonary lobectomy (2000 to 2008) in center A and were used to develop the risk-adjusted score predicting the incidence of PAL (> 5 days). Exclusion criteria were chest wall resection and postoperative assisted mechanical ventilation. No sealants, pleural tent, or buttressing material were used. To build the aggregate score numeric variables were categorized by receiver operating curve analysis. Variables were screened by univariate analysis and then used in stepwise logistic regression analysis (validated by bootstrap). The scoring system was developed by proportional weighing of the significant predictor estimates and was validated on patients operated on in a different center (center B).

Results: The incidence of PAL in the derivation set was 13% (87 of 658 cases). Predictive variables and their scores were the following: age greater than 65 years (1 point); presence of pleural adhesions (1 point); forced expiratory volume in one second less than 80% (1.5 points); and body mass index less than 25.5 kg/m² (2 points). Patients were grouped into 4 risk classes according to their aggregate scores, which were significantly associated with incremental risk of PAL in the validation set of 233 patients.

Conclusions: The developed scoring system reliably predicts incremental risk of PAL after pulmonary lobectomy. Its use may help in identifying those high-risk patients in whom to adopt intraoperative prophylactic strategies; in developing inclusion criteria for future randomized clinical trials on new technologies aimed at reducing or preventing air leak; and for patient counseling.

This article has been cited by other articles:

				A. Brunelli and G. Varela Reply Ann. Thorac. Surg., October 1, 2011; 92(4): 1550 - 1550. [Full Text] [PDF]

				A. Bernard, C. Rivera, P.-E. Falcoz, E. Vicaut, P. Thomas, and M. Dahan Application of Model Score of Prolonged Air Leak in the French Database Ann. Thorac. Surg., October 1, 2011; 92(4): 1548 - 1550. [Full Text] [PDF]

				C. Rivera, A. Bernard, P.-E. Falcoz, P. Thomas, A. Schmidt, S. Benard, E. Vicaut, and M. Dahan Characterization and Prediction of Prolonged Air Leak After Pulmonary Resection: A Nationwide Study Setting Up the Index of Prolonged Air Leak Ann. Thorac. Surg., September 1, 2011; 92(3): 1062 - 1068. [Abstract] [Full Text] [PDF]

				M. Refai, A. Brunelli, M. Salati, C. Pompili, F. Xiume, and A. Sabbatini Efficacy of anterior fissureless technique for right upper lobectomies: a case-matched analysis Eur J Cardiothorac Surg, June 1, 2011; 39(6): 1043 - 1046. [Abstract] [Full Text] [PDF]

				L. Bertolaccini, G. Rizzardi, and A. Terzi A golden key can open any door of new protocol: the use of continuous digital measurement for postoperative air leak Interact CardioVasc Thorac Surg, January 1, 2011; 12(1): 31 - 31. [Full Text] [PDF]