Predictors of Prolonged Air Leak After Lung Resection Surgery

Abstract

Background

Prolonged air leak is one of the most common complications after lung resection surgery and is associated with increased postoperative morbidity, longer chest tube duration, prolonged hospital stay, and higher treatment cost. Identifying patients at increased risk for prolonged air leak is important for perioperative planning and postoperative management.

Objectives

To determine the predictors of prolonged air leak after lung resection surgery and to assess its impact on postoperative outcomes, including hospital stay, intensive care unit admission, and mortality.

Methodology

This retrospective analytical study was conducted at Department of Thoracic Surgery Unit, Lady Reading Hospital Medical Teaching Institution, Peshawar from jan 2019 to jan 2020. A total of 120 patients who underwent lung resection surgery during the study period were included. Demographic characteristics, smoking history, comorbidities, pulmonary function, type of lung resection, operative findings, postoperative air leak duration, hospital stay, ICU admission, and mortality were recorded using a structured data collection form. Prolonged air leak was defined as an air leak persisting for more than five postoperative days. Data were analyzed using SPSS version 24. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. The chi-square test, independent t-test, and binary logistic regression were used where appropriate. A p-value of less than 0.05 was considered statistically significant.

Results

A total of 120 patients were included in the study. The mean age of the patients was 58.6 ± 11.2 years, and males constituted 64% of the study population. Prolonged air leak occurred in 25 patients (20.8%). On analysis, prolonged air leak was more frequent in patients with a history of smoking, chronic obstructive pulmonary disease, reduced preoperative FEV1, upper lobe resection, and intraoperative pleural adhesions. Patients with prolonged air leak had a significantly longer hospital stay compared with those without prolonged air leak (11.8 ± 3.9 days vs 6.7 ± 2.4 days, p = 0.01). ICU admission was required in 14 patients (11.7%), while overall postoperative mortality was 2 patients (1.7%).

Conclusion

Prolonged air leak remains a frequent postoperative complication after lung resection surgery. Smoking history, chronic obstructive pulmonary disease, reduced pulmonary function, upper lobectomy, and pleural adhesions were important predictors. Early identification of high-risk patients may help reduce morbidity, shorten hospital stay, and improve postoperative care.