OBJECTIVES Prolonged air leak (PAL; >5 days) following lung resection is associated with postoperative morbidity. We investigated factors associated with PAL and PAL requiring intervention. METHODS Retrospective review of all patients undergoing lobectomy, segmentectomy or wedge resection from 2016 to 2019 at our institution. Bronchoplastic reconstructions and lung-volume reduction surgeries were excluded. Incidence and risk factors for PAL and PAL requiring intervention were evaluated. RESULTS In total, 2384 patients were included. PAL incidence was 5.4% (129/2384); 22.5% (29/129) required intervention. PAL patients were more commonly male (56.6% vs 39.7%), older (mean age 69 vs 65 years) and underwent lobectomy or thoracotomy (all P < 0.001). Patients with PAL had longer length of stay (9 vs 3 days), more discharge needs and increased odds of complication (all P < 0.050).Twenty-nine patients required intervention (9 chest tubes; 4 percutaneous drains; 16 operations). In 50% of operative interventions, an air leak source was identified; however, the median time from intervention to resolution was 13 days. Patients requiring intervention had increased steroid use, lower diffusion capacity for carbon monoxide and twice the length of stay versus PAL patients (all P < 0.050).On univariable analysis, forced expiratory volume in 1 s (FEV1) <40%, diffusion capacity for carbon monoxide <50%, steroid use and albumin <3 had increased odds of intervention (P < 0.050). CONCLUSIONS Age, gender and operative technique were related to PAL development. Patients with worse forced expiratory volume in 1 s or diffusion capacity for carbon monoxide, steroid use or poor nutrition were less likely to heal on their own, indicating a population that could benefit from earlier intervention.

中文翻译：

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肺切除术后长时间漏气和需要干预的危险因素。

目的 肺切除术后长时间漏气（PAL；>5 天）与术后发病率相关。我们调查了与 PAL 和需要干预的 PAL 相关的因素。方法对我院2016-2019年所有接受肺叶切除、肺段切除或楔形切除的患者进行回顾性分析。支气管成形术重建和肺减容手术被排除在外。评估了 PAL 和需要干预的 PAL 的发生率和危险因素。结果 共纳入 2384 名患者。PAL 发生率为 5.4% (129/2384)；22.5% (29/129) 需要干预。PAL 患者更常见的是男性（56.6% 对 39.7%）、年龄较大（平均年龄 69 对 65 岁）并接受了肺叶切除术或开胸手术（所有 P < 0.001）。PAL 患者的住院时间更长（9 天 vs 3 天），更多的出院需求和增加的并发症发生率（所有 P < 0.050）。29 名患者需要干预（9 个胸管；4 个经皮引流管；16 个手术）。在 50% 的手术干预中，发现了漏气源；然而，从干预到解决的中位时间为 13 天。与 PAL 患者相比，需要干预的患者类固醇使用增加，一氧化碳扩散能力降低，住院时间延长两倍（所有 P < 0.050）。单变量分析显示，1 秒用力呼气量 (FEV1) <40%，扩散能力一氧化碳<50%、类固醇使用和白蛋白<3增加了干预的几率（P<0.050）。结论 年龄、性别和手术技术与 PAL 的发展有关。