Smoking ups prolonged air leak risk after pulmonary surgery

In patients undergoing pulmonary surgery, a history of smoking aggravates the risk of postoperative prolonged air leak (PAL), reports a recent meta-analysis.

Drawing from the online databases of Embase, Web of Science, and PubMed, researchers retrieved 39 eligible studies with a total of 89,006 patients. The quantitative synthesis was conducted using Bayesian random effect models through divergence restricting conditional tessellation (DIRECT) algorithm.

Overall, the pooled incidence of PAL was calculated to be 15 percent. Unadjusted analyses found 30 risk factors, of which 22 were potentially significantly associated with PAL.

Ultimately, five risk factors were found to significantly and independently influence PAL risk. A history of smoking, for instance, aggravates such likelihood by more than 80 percent (odds ratio [OR], 1.84, 95 percent credible interval [CrI], 1.45–2.31; p<0.001).

In addition, preoperative use of steroids increased PAL odds by around 50 percent (OR, 1.51, 95 percent CrI, 0.87–2.65; p=0.031). A lower ratio of forced expiratory volume in 1 second and forced vital capacity also emerged as a risk factor (OR, 1.99, 95 percent CrI, 1.22–3.33; p=0.005).

Moreover, patients who underwent pulmonary with a non-fissureless technique were at greater risk of PAL (OR, 2.14, 95 percent CrI, 1.31–3.66; p=0.003), as were those with pathological TNM stage III/IV (OR, 1.50, 95 percent CrI, 1.07–2.12; p=0.003).

“In-depth research is needed to extend the scope of risk factors and establish a widely applicable prediction model to decrease PAL incidence,” the researchers said.