Air leaks after lobectomy increase the risk of empyema but not of cardiopulmonary complications: a case-matched analysis.
OBJECTIVE
To assess whether the presence and duration of air leaks after lobectomy are associated with an increased incidence of cardiopulmonary complications.


METHODS
Propensity score analysis was used on 726 patients undergoing pulmonary lobectomy from 1995 through 2004 to form three well-matched pairs of patients: patients with prolonged air leak (PAL) [> 7 days] and without air leak; patients with short air leak (SAL) [< or = 7 days] and without air leak; and patients with SAL and PAL. These matched groups were then compared to assess postoperative hospital stay and early outcome.


RESULTS
Patients with SAL had a longer postoperative hospital stay compared to patients without air leak (8.6 days vs 7.8 days, respectively; p < 0.0001) but had similar morbidity and mortality. Patients with PAL had a longer postoperative hospital stay compared to patients without air leak (16.2 days vs 8.3 days, respectively; p < 0.0001) and with SAL (16.9 days vs 9 days, respectively; p < 0.0001), but similar cardiopulmonary complications were noted between the groups. Patients with PAL had a higher rate of empyema compared to patients without air leak and with SAL (8.2% vs 0%, p = 0.01 and 10.4% vs.1.1%, p = 0.01, respectively).


CONCLUSIONS
The presence of air leak was not associated with an increased incidence of cardiopulmonary morbidity but was associated with an increased risk of empyema. Future prospective studies are needed to confirm safety of fast track in patients with air leak.
Brunelli
Alessandro
A
Unit of Thoracic Surgery, "Umberto I" Regional Hospital, Via S. Margherita 23, 60129 Ancona, Italy. alexit_2000@yahoo.com
Xiume
Francesco
F
Al Refai
Majed
M
Salati
Michele
M
Marasco
Rita
R
Sabbatini
Armando
A
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000401:mortality / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000191:economics / Q000209:etiology* / Q000401:mortality; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D016724:Empyema, Pleural / Q000191:economics / Q000209:etiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008171:Lung Diseases / Q000191:economics / Q000209:etiology* / Q000401:mortality; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011013:Pneumonectomy / Q000191:economics; D011030:Pneumothorax / Q000191:economics / Q000209:etiology* / Q000401:mortality; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate