Incidence and risk factors of persistent air leak after major pulmonary resection and use of chemical pleurodesis.
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.
Liberman
Moishe
M
Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Muzikansky
Alona
A
Wright
Cameron D
CD
Wain
John C
JC
Donahue
Dean M
DM
Allan
James S
JS
Gaissert
Henning A
HA
Morse
Christopher R
CR
Mathisen
Douglas J
DJ
Lanuti
Michael
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D018700:Pleurodesis; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000628:therapy*; D012307:Risk Factors; D012907:Smoking; D014797:Vital Capacity; D055815:Young Adult