Patient and Surgical Factors Influencing Air Leak After Lung Volume Reduction Surgery

Lessons Learned From the National Emphysema Treatment Trial

Malcolm M. DeCamp*, Eugene H. Blackstone, Keith S. Naunheim, Mark J. Krasna, Douglas E. Wood, Yvonne M. Meli, Robert J. McKenna

*Corresponding author for this work

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

Background: Although staple line buttressing is advocated to reduce air leak after lung volume reduction surgery (LVRS), its effectiveness is unknown. We sought to identify risk factors for air leak and its duration and to estimate its medical consequences for selecting optimal perioperative technique(s), such as buttressing technique, to preempt or treat post-LVRS air leak. Methods: Detailed air leak data were available for 552 of 580 patients receiving bilateral stapled LVRS in the National Emphysema Treatment Trial. Risk factors for prevalence and duration of air leak were identified by logistic and hazard function analyses. Medical consequences were estimated in propensity-matched pairs with and without air leak. Results: Within 30 days of LVRS, 90% of patients developed air leak (median duration = 7 days). Its occurrence was more common and duration prolonged in patients with lower diffusing capacity (p = 0.06), upper lobe disease (p = 0.04), and important pleural adhesions (p = 0.007). Duration was also protracted in Caucasians (p < 0.0001), patients using inhaled steroids (p = 0.004), and those with lower 1-second forced expiratory volume (p = 0.0003). Surgical approach, buttressing, stapler brand, and intraoperative adjunctive procedures were not associated with fewer or less prolonged air leaks (p ≥ 0.2). Postoperative complications occurred more often in matched patients experiencing air leak (57% vs 30%, p = 0.0004), and postoperative stay was longer (11.8 ± 6.5 days vs 7.6 ± 4.4 days, p = 0.0005). Conclusions: Air leak accompanies LVRS in 90% of patients, is often prolonged, and is associated with a more complicated and protracted hospital course. Its occurrence and duration are associated with characteristics of patients and their disease, not with a specific surgical technique.

Original languageEnglish (US)
Pages (from-to)197-207
Number of pages11
JournalAnnals of Thoracic Surgery
Volume82
Issue number1
DOIs
StatePublished - Jul 1 2006

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Pneumonectomy
Emphysema
Air
Therapeutics
Forced Expiratory Volume
Steroids

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

DeCamp, Malcolm M. ; Blackstone, Eugene H. ; Naunheim, Keith S. ; Krasna, Mark J. ; Wood, Douglas E. ; Meli, Yvonne M. ; McKenna, Robert J. / Patient and Surgical Factors Influencing Air Leak After Lung Volume Reduction Surgery : Lessons Learned From the National Emphysema Treatment Trial. In: Annals of Thoracic Surgery. 2006 ; Vol. 82, No. 1. pp. 197-207.
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title = "Patient and Surgical Factors Influencing Air Leak After Lung Volume Reduction Surgery: Lessons Learned From the National Emphysema Treatment Trial",
abstract = "Background: Although staple line buttressing is advocated to reduce air leak after lung volume reduction surgery (LVRS), its effectiveness is unknown. We sought to identify risk factors for air leak and its duration and to estimate its medical consequences for selecting optimal perioperative technique(s), such as buttressing technique, to preempt or treat post-LVRS air leak. Methods: Detailed air leak data were available for 552 of 580 patients receiving bilateral stapled LVRS in the National Emphysema Treatment Trial. Risk factors for prevalence and duration of air leak were identified by logistic and hazard function analyses. Medical consequences were estimated in propensity-matched pairs with and without air leak. Results: Within 30 days of LVRS, 90{\%} of patients developed air leak (median duration = 7 days). Its occurrence was more common and duration prolonged in patients with lower diffusing capacity (p = 0.06), upper lobe disease (p = 0.04), and important pleural adhesions (p = 0.007). Duration was also protracted in Caucasians (p < 0.0001), patients using inhaled steroids (p = 0.004), and those with lower 1-second forced expiratory volume (p = 0.0003). Surgical approach, buttressing, stapler brand, and intraoperative adjunctive procedures were not associated with fewer or less prolonged air leaks (p ≥ 0.2). Postoperative complications occurred more often in matched patients experiencing air leak (57{\%} vs 30{\%}, p = 0.0004), and postoperative stay was longer (11.8 ± 6.5 days vs 7.6 ± 4.4 days, p = 0.0005). Conclusions: Air leak accompanies LVRS in 90{\%} of patients, is often prolonged, and is associated with a more complicated and protracted hospital course. Its occurrence and duration are associated with characteristics of patients and their disease, not with a specific surgical technique.",
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Patient and Surgical Factors Influencing Air Leak After Lung Volume Reduction Surgery : Lessons Learned From the National Emphysema Treatment Trial. / DeCamp, Malcolm M.; Blackstone, Eugene H.; Naunheim, Keith S.; Krasna, Mark J.; Wood, Douglas E.; Meli, Yvonne M.; McKenna, Robert J.

In: Annals of Thoracic Surgery, Vol. 82, No. 1, 01.07.2006, p. 197-207.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Patient and Surgical Factors Influencing Air Leak After Lung Volume Reduction Surgery

T2 - Lessons Learned From the National Emphysema Treatment Trial

AU - DeCamp, Malcolm M.

AU - Blackstone, Eugene H.

AU - Naunheim, Keith S.

AU - Krasna, Mark J.

AU - Wood, Douglas E.

AU - Meli, Yvonne M.

AU - McKenna, Robert J.

PY - 2006/7/1

Y1 - 2006/7/1

N2 - Background: Although staple line buttressing is advocated to reduce air leak after lung volume reduction surgery (LVRS), its effectiveness is unknown. We sought to identify risk factors for air leak and its duration and to estimate its medical consequences for selecting optimal perioperative technique(s), such as buttressing technique, to preempt or treat post-LVRS air leak. Methods: Detailed air leak data were available for 552 of 580 patients receiving bilateral stapled LVRS in the National Emphysema Treatment Trial. Risk factors for prevalence and duration of air leak were identified by logistic and hazard function analyses. Medical consequences were estimated in propensity-matched pairs with and without air leak. Results: Within 30 days of LVRS, 90% of patients developed air leak (median duration = 7 days). Its occurrence was more common and duration prolonged in patients with lower diffusing capacity (p = 0.06), upper lobe disease (p = 0.04), and important pleural adhesions (p = 0.007). Duration was also protracted in Caucasians (p < 0.0001), patients using inhaled steroids (p = 0.004), and those with lower 1-second forced expiratory volume (p = 0.0003). Surgical approach, buttressing, stapler brand, and intraoperative adjunctive procedures were not associated with fewer or less prolonged air leaks (p ≥ 0.2). Postoperative complications occurred more often in matched patients experiencing air leak (57% vs 30%, p = 0.0004), and postoperative stay was longer (11.8 ± 6.5 days vs 7.6 ± 4.4 days, p = 0.0005). Conclusions: Air leak accompanies LVRS in 90% of patients, is often prolonged, and is associated with a more complicated and protracted hospital course. Its occurrence and duration are associated with characteristics of patients and their disease, not with a specific surgical technique.

AB - Background: Although staple line buttressing is advocated to reduce air leak after lung volume reduction surgery (LVRS), its effectiveness is unknown. We sought to identify risk factors for air leak and its duration and to estimate its medical consequences for selecting optimal perioperative technique(s), such as buttressing technique, to preempt or treat post-LVRS air leak. Methods: Detailed air leak data were available for 552 of 580 patients receiving bilateral stapled LVRS in the National Emphysema Treatment Trial. Risk factors for prevalence and duration of air leak were identified by logistic and hazard function analyses. Medical consequences were estimated in propensity-matched pairs with and without air leak. Results: Within 30 days of LVRS, 90% of patients developed air leak (median duration = 7 days). Its occurrence was more common and duration prolonged in patients with lower diffusing capacity (p = 0.06), upper lobe disease (p = 0.04), and important pleural adhesions (p = 0.007). Duration was also protracted in Caucasians (p < 0.0001), patients using inhaled steroids (p = 0.004), and those with lower 1-second forced expiratory volume (p = 0.0003). Surgical approach, buttressing, stapler brand, and intraoperative adjunctive procedures were not associated with fewer or less prolonged air leaks (p ≥ 0.2). Postoperative complications occurred more often in matched patients experiencing air leak (57% vs 30%, p = 0.0004), and postoperative stay was longer (11.8 ± 6.5 days vs 7.6 ± 4.4 days, p = 0.0005). Conclusions: Air leak accompanies LVRS in 90% of patients, is often prolonged, and is associated with a more complicated and protracted hospital course. Its occurrence and duration are associated with characteristics of patients and their disease, not with a specific surgical technique.

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