title: Identifying Patients at Higher Risk of Prolonged Air Leak After Lung Resection.
abstract: BACKGROUND
  Predictive models of prolonged air leak have relied on information not always available preoperatively (eg, extent of resection, pleural adhesions). Our objective was to construct a model to identify patients at increased risk of prolonged air leak using preoperative factors exclusively.
  
  
  METHODS
  From 2012 to 2014, data on consecutive patients undergoing pulmonary resection were collected prospectively. Prolonged air leak was defined as lasting longer than 7 days and requiring hospitalization. Factors associated with the primary outcome (p < 0.2) were included in a multivariate model. Regression coefficients were used to develop a weighted risk score for prolonged air leak.
  
  
  RESULTS
  Of 225 patients, 8% (18/225) experienced a prolonged air leak. Male gender (p = 0.08), smoking history (p = 0.03), body mass index (BMI) 25 or below (p < 0.01), Medical Research Council (MRC) dyspnea score above 1 (p = 0.06), and diffusion capacity for carbon monoxide below 80% (Dlco) (p = 0.01) were selected for inclusion in the final model. Weighted scores were male gender (1 point), BMI 25 or below (0.5 point), smoker (2 points), Dlco% below 80% (2 points), and MRC dyspnea score above 1 (1 point). The area under the receiver operating characteristic curve was 0.8 (95% confidence interval [CI] = 0.7 to 0.9]. An air leak score above 4 points offered the best combination of sensitivity (83% [95% CI = 58 to 96]) and specificity (65% [95% CI = 58 to 71]).
  
  
  CONCLUSIONS
  A subgroup of lung resection patients at higher risk for a prolonged air leak can be effectively identified with the use of widely available, preoperative factors. The proposed scoring system is simple, is clinically relevant to the informed consent, and allows preoperative patient selection for interventions to reduce the risk of prolonged air leak.
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: sgilbert@toh.on.ca.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gilbert
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Sonam
authors.initials: S
authors.lastname: Maghera
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Seely
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Donna E
authors.initials: DE
authors.lastname: Maziak
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Farid M
authors.initials: FM
authors.lastname: Shamji
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Sudhir R
authors.initials: SR
authors.lastname: Sundaresan
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Villeneuve
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000453:epidemiology; D001980:Bronchi / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010995:Pleural Diseases / Q000175:diagnosis* / Q000453:epidemiology; D011013:Pneumonectomy / Q000009:adverse effects*; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors