Objective

Prolonged air leak (PAL) is one of the most common complications after pulmonary resection for lung cancer. This study aimed to identify the factors that predict PAL, and to evaluate the impact of PAL on the development of additional complications and cost of hospitalization.

Methods

A total of 2278 patients who underwent pulmonary resection other than pneumonectomy for lung cancer from 2014 to 2018 were retrospectively enrolled in this study. PAL was defined as air leak that continued more than 5 days after the operation. Multivariate analyses were conducted to identify significant predictors of PAL, using clinical information. Development of complications other than PAL, and cost of hospitalization care were also analyzed.

Results

PAL was observed in 91 (4.0%) cases. Multivariate logistic regression analysis revealed that the presence of intrathoracic adhesion (odds ratio [OR] 4.476, p < 0.001), smoking history > 20 pack-year (OR 2.441, p = 0.005), male sex (OR 2.269, p = 0.013), and lobectomy or bilobectomy (OR 1.935, p = 0.025) were significant risk factors for PAL. The presence of PAL was related to the development of additional complications (p < 0.001). The cost of hospitalization care in patients with PAL was about 1.3 times higher than that in patients without PAL (p < 0.001).

Conclusions

PAL is related to additional complications and higher cost of hospitalization care. Surgeons should pay careful attention to minimize the incidence of PAL in patients with risk factors including intrathoracic adhesion, history of heavy smoking, male sex, and lobectomy or bilobectomy.

中文翻译：

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肺切除术后长时间漏气的预测因素及经济影响

客观的

长时间漏气（PAL）是肺癌肺切除术后最常见的并发症之一。本研究旨在确定预测 PAL 的因素，并评估 PAL 对发生额外并发症和住院费用的影响。

方法

本研究回顾性纳入2014年至2018年因肺癌行除全肺切除术以外的肺切除术的2278例患者。PAL 定义为手术后持续 5 天以上的漏气。使用临床信息进行多变量分析以确定 PAL 的重要预测因子。还分析了除 PAL 以外的并发症的发展，以及住院治疗的费用。

结果

在 91 例 (4.0%) 病例中观察到 PAL。多变量逻辑回归分析显示存在胸腔内粘连（优势比 [OR] 4.476，p  < 0.001），吸烟史 > 20 包年（OR 2.441，p  = 0.005），男性（OR 2.269，p  = 0.013） , 肺叶切除术或双叶切除术 (OR 1.935, p  = 0.025) 是 PAL 的重要危险因素。PAL 的存在与其他并发症的发生有关 ( p  < 0.001)。PAL 患者的住院治疗费用约为非 PAL 患者的 1.3 倍（p  < 0.001）。

结论

PAL 与额外的并发症和更高的住院治疗费用有关。外科医生应注意尽量减少胸腔内粘连、重度吸烟史、男性、肺叶切除术或双叶切除术等危险因素患者的 PAL 发生率。