Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Using Continuous Flow Data to Predict the Course of Air Leaks After Lung Lobectomy

  • Jaeshin Yoon (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kwanyong Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Sook Whan Sung (Department of Thoracic and Cardiovascular Surgery, Ewha Womens University Seoul Hospital)
  • Received : 2022.10.31
  • Accepted : 2023.01.12
  • Published : 2023.05.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Assessments of air leaks are usually performed subjectively, precluding the use of air leaks as an evaluation factor. We aimed to identify objective parameters as predictive factors for prolonged air leak (PAL) and air leak cessation (ALC) from air flow data produced by a digital drainage system. Methods: Flow data records of 352 patients who underwent lung lobectomy were reviewed, and flow data at designated intervals (1, 2, and 3 hours postoperatively [POH] and 3 times a day thereafter [06:00, 13:00, 19:00]) were extracted. ALC was defined by flow less than 20 mL/min over 12 hours, and PAL was defined as ALC after 5 days. Cumulative incidence curves were obtained using Kaplan-Meier estimates of time to ALC. Cox regression analysis was performed to determine the effects of variables on the rate of ALC. Results: The incidence of PAL was 18.2% (64/352). Receiver operating characteristic curve analysis showed cut-off values of 180 mL/min for the flow at 3 POH and 73.3 mL/min for the flow on postoperative day 1; the sensitivity and specificity of these values were 88.9% and 82.5%, respectively. The rates of ALC by Kaplan-Meier analysis were 56.8% at 48 POH and 65.6% at 72 POH. Multivariate Cox regression analysis revealed that the flow at 3 POH (≤80 mL/min), operation time (≤220 minutes), and right middle lobectomy independently predicted ALC. Conclusion: Air flow measured by a digital drainage system is a useful predictor of PAL and ALC and may help optimize the hospital course.

Keywords

Acknowledgement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References

  1. Brunelli A, Xiume F, Al Refai M, Salati M, Marasco R, Sabbatini A. Air leaks after lobectomy increase the risk of empyema but not of cardiopulmonary complications: a case-matched analysis. Chest 2006;130:1150-6. https://doi.org/10.1378/chest.130.4.1150
  2. Irshad K, Feldman LS, Chu VF, Dorval JF, Baslaim G, Morin JE. Causes of increased length of hospitalization on a general thoracic surgery service: a prospective observational study. Can J Surg 2002;45:264-8.
  3. Varela G, Jimenez MF, Novoa N, Aranda JL. Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy. Eur J Cardiothorac Surg 2005;27:329-33. https://doi.org/10.1016/j.ejcts.2004.11.005
  4. Okereke I, Murthy SC, Alster JM, Blackstone EH, Rice TW. Characterization and importance of air leak after lobectomy. Ann Thorac Surg 2005;79:1167-73. https://doi.org/10.1016/j.athoracsur.2004.08.069
  5. 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. https://doi.org/10.1016/j.ejcts.2010.12.027
  6. 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. https://doi.org/10.1016/j.ejcts.2008.09.005
  7. Attaar A, Winger DG, Luketich JD, et al. A clinical prediction model for prolonged air leak after pulmonary resection. J Thorac Cardiovasc Surg 2017;153:690-9. https://doi.org/10.1016/j.jtcvs.2016.10.003
  8. 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. https://doi.org/10.1093/ejcts/ezs518
  9. Brunelli A, Varela G, Refai M, et al. A scoring system to predict the risk of prolonged air leak after lobectomy. Ann Thorac Surg 2010;90:204-9. https://doi.org/10.1016/j.athoracsur.2010.02.054
  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. https://doi.org/10.1016/j.athoracsur.2016.03.089
  11. Petrella F, Rizzo S, Radice D, et al. Predicting prolonged air leak after standard pulmonary lobectomy: computed tomography assessment and risk factors stratification. Surgeon 2011;9:72-7. https://doi.org/10.1016/j.surge.2010.07.010
  12. 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. https://doi.org/10.1510/icvts.2011.280941
  13. Shoji F, Takamori S, Akamine T, et al. Clinical evaluation and outcomes of digital chest drainage after lung resection. Ann Thorac Cardiovasc Surg 2016;22:354-8. https://doi.org/10.5761/atcs.oa.16-00179
  14. Brunelli A, Monteverde M, Borri A, Salati M, Marasco RD, Fianchini A. Predictors of prolonged air leak after pulmonary lobectomy. Ann Thorac Surg 2004;77:1205-10. https://doi.org/10.1016/j.athoracsur.2003.10.082
  15. Cerfolio RJ, Bass CS, Pask AH, Katholi CR. Predictors and treatment of persistent air leaks. Ann Thorac Surg 2002;73:1727-31. https://doi.org/10.1016/s0003-4975(02)03531-2
  16. Goto M, Aokage K, Sekihara K, et al. Prediction of prolonged air leak after lung resection using continuous log data of flow by digital drainage system. Gen Thorac Cardiovasc Surg 2019;67:684-9. https://doi.org/10.1007/s11748-019-01073-y
  17. Oh SG, Jung Y, Jheon S, et al. Postoperative air leak grading is useful to predict prolonged air leak after pulmonary lobectomy. J Cardiothorac Surg 2017;12:1. https://doi.org/10.1186/s13019-017-0568-6
  18. Orsini B, Baste JM, Gossot D, 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. https://doi.org/10.1093/ejcts/ezu505
  19. Cerfolio RJ, Bass C, Katholi CR. Prospective randomized trial compares suction versus water seal for air leaks. Ann Thorac Surg 2001; 71:1613-7. https://doi.org/10.1016/s0003-4975(01)02474-2
  20. Sakamoto T, Nishio W, Okada M, Harada H, Uchino K, Tsubota N. Management of air leak after pulmonary resection. Jpn J Thorac Cardiovasc Surg 2004;52:292-5. https://doi.org/10.1007/s11748-004-0045-8
  21. Esomonu UG, Taura MG, Modibbo MH, Egwu AO. Variation in the lobar pattern of the right and left lungs: a case report. Australas Med J 2013;6:511-4. https://doi.org/10.4066/AMJ.2013.1856
  22. Mpolokeng KS, Madolo MY, Louw GJ, Gunston G. Anatomical variations in lung fissures leading to supernumerary lobes in the lungs. Transl Res Anat 2022;28:100209. https://doi.org/10.1016/j.tria.2022.100209