title: Postoperative air leak grading is useful to predict prolonged air leak after pulmonary lobectomy.
abstract: BACKGROUND
  Results of studies to predict prolonged air leak (PAL; air leak longer than 5 days) after pulmonary lobectomy have been inconsistent and are of limited use. We developed a new scale representing the amount of early postoperative air leak and determined its correlation with air leak duration and its potential as a predictor of PAL.
  
  
  METHODS
  We grade postoperative air leak using a 5-grade scale. All 779 lobectomies from January 2005 to December 2009 with available medical records were reviewed retrospectively. We devised six 'SUM' variables using air leak grades in the initial 72 h postoperatively.
  
  
  RESULTS
  Excluding unrecorded cases and postoperative broncho-pleural fistulas, there were 720 lobectomies. PAL occurred in 135 cases (18.8%). Correlation analyses showed each SUM variable highly correlated with air leak duration, and the SUM4to9, which was the sum of six consecutive values of air leak grades for every 8 h record on postoperative days 2 and 3, was proved to be the most powerful predictor of PAL; PAL could be predicted with 75.7% and 77.7% positive and negative predictive value, respectively, when SUM4to9≥ 16. When 4 predictors derived from multivariable logistic regression of perioperative variables were combined with SUM4to9, there was no significant increase in predictability compared with SUM4to9alone.
  
  
  CONCLUSIONS
  This simple new method to predict PAL using SUM4to9showed that the amount of early postoperative air leak is the most powerful predictor of PAL, therefore, grading air leak after pulmonary lobectomy is a useful method to predict PAL.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42 Jebong-ro, 501-757, Dong-gu, Gwangju, South Korea.
authors.forename: Sang Gi
authors.initials: SG
authors.lastname: Oh
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42 Jebong-ro, 501-757, Dong-gu, Gwangju, South Korea. yochuni@naver.com.
authors.forename: Yochun
authors.initials: Y
authors.lastname: Jung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Jheon
authors.affiliation: Medical Research Collaborating Center, Seoul National University College of Medicine / Seoul National University Hospital, Seoul, South Korea.
authors.forename: Yunhee
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun, South Korea.
authors.forename: Ju Sik
authors.initials: JS
authors.lastname: Yun
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun, South Korea.
authors.forename: Kook Joo
authors.initials: KJ
authors.lastname: Na
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42 Jebong-ro, 501-757, Dong-gu, Gwangju, South Korea. bhahn@chonnam.ac.kr.
authors.forename: Byoung Hee
authors.initials: BH
authors.lastname: Ahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011030:Pneumothorax / Q000175:diagnosis* / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
keywords: Air leak grade; Lobectomy; Prolonged air leak