Patient and Surgical Factors Influencing Air Leak After Lung Volume Reduction Surgery: Lessons Learned From the National Emphysema Treatment Trial

Autor: Malcolm M, DeCamp, Eugene H, Blackstone, Keith S, Naunheim, Mark J, Krasna, Douglas E, Wood, Yvonne M, Meli, Robert J, McKenna, Arthur, Gelb
Rok vydání: 2006
Předmět:
Male
Pulmonary and Respiratory Medicine
Thorax
medicine.medical_specialty
Matched-Pair Analysis
medicine.medical_treatment
Tissue Adhesions
Fibrin Tissue Adhesive
Lung volume reduction surgery
White People
Pneumonectomy
Postoperative Complications
Surgical Staplers
Adrenal Cortex Hormones
Risk Factors
Forced Expiratory Volume
Diffusing capacity
Administration
Inhalation
Surgical Stapling
Prevalence
medicine
Animals
Humans
Lung volumes
Polytetrafluoroethylene
Pleurodesis
Aged
Randomized Controlled Trials as Topic
Bioprosthesis
Thoracic Surgery
Video-Assisted
business.industry
Suture Techniques
Respiratory disease
Pneumothorax
Perioperative
Middle Aged
Pleural Diseases
medicine.disease
Surgery
Pulmonary Emphysema
Cardiothoracic surgery
Cattle
Female
Cardiology and Cardiovascular Medicine
business
Pericardium
Zdroj: The Annals of Thoracic Surgery. 82:197-207
ISSN: 0003-4975
Popis: 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.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.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 (p0.0001), 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).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.
Databáze: OpenAIRE
Externí odkaz: