title: Predicting prolonged air leak after standard pulmonary lobectomy: computed tomography assessment and risk factors stratification.
abstract: BACKGROUND
  Prolonged air leak after pulmonary lobectomy is a common time- and cost-consuming complication. Its prevention may significantly reduce hospitalization length and costs offering patients a standard uneventful postoperative course. The aim of the present study is to identify predictors of prolonged postoperative air leak and to stratify preoperative risk factors.
  
  
  METHODS
  From July 2004 to December 2007 241 consecutive standard lobectomies were performed with curative intent for lung cancer. After excluding patients not fulfilling the inclusion criterion, 58 patients were enrolled in the "prolonged air leak" group and 63 patients were enrolled in the "standard outcome" group.
  
  
  RESULTS
  Total lung capacity (p=0.0038) and percentage emphysema (p=0.0050) calculated by computed tomography were both significantly related to prolonged postoperative air leak; the values of 4773cc and 0.4% showed the highest predictive value in terms of sensitivity (84.5% and 75.9% respectively). Multivariate logistic regression disclosed that male sex (p=0.0006), right side of operation (p=0.0010) and age (p=0.0082) were significantly related to prolonged postoperative air leak. Preoperative chemotherapy (p=0.0940) did not affect air leak status.
  
  
  CONCLUSIONS
  Computed tomography quantification of emphysema is the best predictor of prolonged air leak. Age, male sex and right side lobectomy are correlated to this complication. Preoperative chemotherapy is not an additional risk factor.
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Via Ripamonti 435, Milan, Italy. francesco.petrella@ieo.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Petrella
authors.forename: Stefania
authors.initials: S
authors.lastname: Rizzo
authors.forename: Davide
authors.initials: D
authors.lastname: Radice
authors.forename: Alessandro
authors.initials: A
authors.lastname: Borri
authors.forename: Domenico
authors.initials: D
authors.lastname: Galetta
authors.forename: Roberto
authors.initials: R
authors.lastname: Gasparri
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Solli
authors.forename: Giulia
authors.initials: G
authors.lastname: Veronesi
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellomi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
mesh_terms: D000368:Aged; D057868:Anastomotic Leak; D016724:Empyema, Pleural / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000601:surgery; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging; D012372:ROC Curve; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed