title: Standardized Approach to Prolonged Air Leak Reduction After Pulmonary Resection.
abstract: BACKGROUND
  Prolonged air leaks after pulmonary resection lead to patient discomfort, increased hospital length of stay, greater health care costs, and increased morbidity. A standardized approach to air leak reduction (STAR) after lung resection was developed and studied.
  
  
  METHODS
  A retrospective review was conducted of a prospective database from 1 surgeon who had adopted STAR as standard of care. Three independent factors shown to reduce air leaks are incorporated in STAR: fissureless operative technique, staple line buttressing, and protocol-driven chest tube management. Patient characteristics and outcomes were compared against aggregate data from The Society of Thoracic Surgeons National Database (2012-2014).
  
  
  RESULTS
  From June 2010 through May 2015, 475 patients met the study criteria. Of these, 264 (55.6%) had lobectomies, 198 (41.7%) had wedge resections, and 13 (2.7%) had segmentectomies. Prolonged air leaks were reduced in the STAR lobectomy group by 52% (5.7% versus 10.9%; p = 0.0079) and in the STAR wedge group by 40% (2.5% versus 4.2%; p = 0.38). Hospital length of stay for lobectomies (3.2 versus 6.3 days; p = 0.0001), wedge resections (3.3 versus 4.5 days; p = 0.0152), and segmentectomies (3.2 versus 5.2 days; p = 0.0001) was significantly reduced. Readmission rate was 4% and none were related to air leak. No difference was seen in mortality rates.
  
  
  CONCLUSIONS
  Use of STAR for pulmonary resection, particularly for lobectomies, shows decreased postoperative prolonged air leaks when compared with The Society of Thoracic Surgeons National Database. This aggressive approach did not lead to air leak-related hospital readmissions nor compromise postoperative mortality. The STAR protocol is an innovative strategy that has the potential to improve postoperative pulmonary resection outcomes.
authors.affiliation: Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Drahush
authors.affiliation: Alliance of Cardiac, Thoracic and Vascular Surgeons, Chattanooga, Tennessee. Electronic address: amiller@actversusurgeons.com.
authors.forename: Ashley D
authors.initials: AD
authors.lastname: Miller
authors.affiliation: Alliance of Cardiac, Thoracic and Vascular Surgeons, Chattanooga, Tennessee.
authors.forename: Jeremiah S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Royer
authors.affiliation: Alliance of Cardiac, Thoracic and Vascular Surgeons, Chattanooga, Tennessee.
authors.forename: Marlana
authors.initials: M
authors.lastname: Spiva
authors.affiliation: Alliance of Cardiac, Thoracic and Vascular Surgeons, Chattanooga, Tennessee.
authors.forename: James R
authors.initials: JR
authors.lastname: Headrick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D015505:Chest Tubes; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011030:Pneumothorax / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D017792:Surgical Stapling