title: 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.
abstract: OBJECTIVE
  The incidence rate of prolonged air leak (PAL) after lobectomy, defined as any air leak prolonged beyond 7 days, can be estimated to be in between 6 and 15%. In 2011, the Epithor group elaborated an accurate predictive score for PAL after open lung resections, so-called IPAL (index of prolonged air leak), from a nation-based surgical cohort constituted between 2004 and 2008. Since 2008, video-assisted thoracic surgery (VATS) has become popular in France among the thoracic surgical community, reaching almost 14% of lobectomies performed with this method in 2012. This minimally invasive approach was reported as a means to reduce the duration of chest tube drainage. The aim of our study was thus to validate the IPAL scoring system in patients having received VATS anatomical lung resections.
  
  
  METHODS
  We collected all anatomical VATS lung resections (lobectomy and segmentectomy) registered in the French national general thoracic surgery database (EPITHOR) between 2009 and 2012. The area under the receiver operating characteristic (ROC) curve estimated the discriminating value of the IPAL score. The slope value described the relation between the predicted and observed incidences of PALs. The Hosmer-Lemeshow test was also used to estimate the quality of adequacy between predicted and observed values.
  
  
  RESULTS
  A total of 1233 patients were included: 1037 (84%) lobectomies and 196 (16%) segmentectomies. In 1099 cases (89.1%), the resection was performed for a malignant disease. Ninety-six patients (7.7%) presented with a PAL. The IPAL score provided a satisfactory predictive value with an area under the ROC curve of 0.72 (0.67-0.77). The value of the slope, 1.25 (0.9-1.58), and the Hosmer-Lemeshow test (χ(2) = 11, P = 0.35) showed that predicted and observed values were adequate.
  
  
  CONCLUSIONS
  The IPAL score is valid for the estimation of the predictive risk of PAL after VATS lung resections. It may thus a priori be used to characterize any surgical population submitted to potential preventive measures.
authors.affiliation: Department of Thoracic Surgery and Diseases of Esophagus, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, North Hospital, Marseille, France bastienorsini1@gmail.com.
authors.forename: Bastien
authors.initials: B
authors.lastname: Orsini
authors.affiliation: Department of Thoracic Surgery, CHU Rouen, Rouen, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Baste
authors.affiliation: Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Gossot
authors.affiliation: Department of Thoracic and Vascular Surgery, CHU Montpellier, Montpellier, France.
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Berthet
authors.affiliation: Department of Thoracic Surgery, Assistance Publique Hôpitaux de Paris, Tenon Hospital, Paris, France.
authors.forename: Jalal
authors.initials: J
authors.lastname: Assouad
authors.affiliation: Department of Thoracic Surgery, CHU Toulouse, Larrey Hospital, Toulouse, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Dahan
authors.affiliation: Department of Thoracic Surgery, CHU Dijon, Bocage Hospital, Dijon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Bernard
authors.affiliation: Department of Thoracic Surgery and Diseases of Esophagus, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, North Hospital, Marseille, France.
authors.forename: Pascal Alexandre
authors.initials: PA
authors.lastname: Thomas
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors
keywords: Air leaks; Lobectomy; Video-assisted thoracic surgery