What puts pulmonary surgery patients at risk of prolonged air leak?

In patients undergoing pulmonary surgery, smoking history, preoperative steroid use, and advanced malignancy increase the risk of prolonged air leak (PAL), reports a recent study.

Drawing from the online databases of PubMed, Embase, and Web of Science, the researchers retrieved 39 studies eligible for meta-analysis, including a total of 89,006 patients who had received pulmonary surgery. Most (n=35) included studies were found to have low risk of bias in all aspects evaluated. Nevertheless, of 30 risk factors assessed, 29 had low or very low quality of evidence.

Pooled analysis revealed five risk factors for PAL with high evidence quality. Smoking history, for instance, increased the likelihood of PAL by more than 80 percent (odds ratio [OR], 1.84, 95 percent credible intervals (CrI), 1.45–2.31; p<0.001). Meanwhile, use of preoperative steroids aggravated such odds by around 50 percent (OR, 1.51, 95 percent CrI, 0.87–2.65; p=0.031).

A lower ratio of the forced expiratory volume in 1 second to the forced vital capacity nearly doubled the likelihood of PAL (OR, 1.99, 95 percent CrI, 1.22–3.33; p=0.005). A similar effect was found for patients who underwent nonfissureless surgical techniques (OR, 2.14, 95 percent CrI, 1.31–3.66; p=0.003).

Moreover, malignancy increased the odds of PAL over benign disease, particularly in those with pathological tumour node metastasis stages 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.