A Scoring System to Predict the Risk of Prolonged Air Leak After Lobectomy

Abstract

Background. Prolonged air leak (PAL) remains a fre- quent complication after lung resection. Perioperative preventative strategies have been tested, but their effi- cacy is often difficult to interpret due to heterogeneous inclusion criteria. The objective of this study was to develop and validate a practical score to stratify the risk of PAL after lobectomy. Methods. Six hundred fifty-eight consecutive patients were submitted to pulmonary lobectomy (2000 to 2008) in center A and were used to develop the risk-adjusted score predicting the incidence of PAL (>5 days). Exclu- sion criteria were chest wall resection and postopera- tive assisted mechanical ventilation. No sealants, pleu- ral tent, or buttressing material were used. To build the aggregate score numeric variables were categorized by receiver operating curve analysis. Variables were screened by univariate analysis and then used in stepwise logistic regression analysis (validated by bootstrap). The scoring system was developed by pro- portional weighing of the significant predictor esti- mates and was validated on patients operated on in a different center (center B). Results. The incidence of PAL in the derivation set was 13% (87 of 658 cases). Predictive variables and their scores were the following: age greater than 65 years (1 point); presence of pleural adhesions (1 point); forced expiratory volume in one second less than 80% (1.5 points); and body mass index less than 25.5 kg/m2 (2 points). Patients were grouped into 4 risk classes according to their aggregate scores, which were significantly associated with incremen- tal risk of PAL in the validation set of 233 patients. Conclusions. The developed scoring system reliably predicts incremental risk of PAL after pulmonary lobec- tomy. Its use may help in identifying those high-risk patients in whom to adopt intraoperative prophylactic strat- egies; in developing inclusion criteria for future random- ized clinical trials on new technologies aimed at reducing or preventing air leak; and for patient counseling.