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Prolonged Air Leak After Pulmonary Resection Increases Risk of Noncardiac Complications, Readmission, and Delayed Hospital Discharge: A Propensity Score-adjusted Analysis.

Abstract：

OBJECTIVE:The aim of the study was to determine whether prolonged air leak (PAL) is associated with postoperative morbidity and mortality following pulmonary resection after adjusting for differences in baseline characteristics using propensity score analysis. SUMMARY BACKGROUND DATA:Patients with PAL after lung resection have worse outcomes than those without PAL. However, adverse postoperative outcomes may also be secondary to baseline risk factors, such as poor lung function. METHODS:Patients who underwent pulmonary resection for lung cancer/nodules (1/2009-6/2014) were stratified by the presence of PAL [n = 183 with/1950 without; defined as >5 d postoperative air leak; n = 189 (8.3%)]; probability estimates for propensity for PAL from 31 pretreatment/intraoperative variables were generated. Inverse probability-of-treatment weights were applied and outcomes assessed with logistic regression. RESULTS:Standardized bias between groups was significantly reduced after propensity weighting (mean = 0.18 before vs 0.08 after, P < 0.01). After propensity weighting, PAL was associated with increased odds of empyema (OR = 8.5; P < 0.001), requirement for additional chest tubes for pneumothorax (OR = 7.5; P < 0.001), blood transfusion (OR = 2; P = 0.03), pulmonary complications (OR = 4; P < 0.001), unexpected return to operating room (OR = 4; P < 0.001), and 30-day readmission (OR = 2; P = 0.009). Among other complications, odds of cardiac complications (P = 0.493), unexpected ICU admission (P = 0.156), and 30-day mortality (P = 0.270) did not differ. Length of hospital stay was prolonged (5.04 d relative effect, 95% confidence interval, 3.77-6.30; P < 0.001). CONCLUSIONS:Pulmonary complications, readmission, and delayed hospital discharge are directly attributable to having a PAL, whereas cardiac complications, unexpected admission to the ICU, and 30-day mortality are not after propensity score adjustment.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Attaar A,Luketich JD,Schuchert MJ,Winger DG,Sarkaria IS,Nason KS

doi

10.1097/SLA.0000000000003191

subject

Has Abstract

pub_date

2021-01-01 00:00:00

pages

163-172

issue

eissn

0003-4932

issn

1528-1140

pii

00000658-202101000-00024

journal_volume

273

pub_type

杂志文章

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Prolonged Air Leak After Pulmonary Resection Increases Risk of Noncardiac Complications, Readmission, and Delayed Hospital Discharge: A Propensity Score-adjusted Analysis.