A risk score to predict the incidence of prolonged air leak after video-assisted thoracoscopic lobectomy: An analysis from the European Society of Thoracic Surgeons database
A risk score to predict the incidence of prolonged air leak after video-assisted thoracoscopic lobectomy: An analysis from the European Society of Thoracic Surgeons database
复制标题
DOI：
10.1016/j.jtcvs.2016.11.064
复制
发表时间：
2017-04-01
影响因子：
6
通讯作者：
Brunelli, Alessandro
中科院分区：
文献类型：
--
作者：
Pompili, Cecilia;Falcoz, Pierre Emmanuel;Brunelli, Alessandro
目的：研究目的是建立一个综合风险评分，以预测在欧洲胸外科学会数据库中登记的患者在视频辅助胸腔镜肺叶切除术后发生长时间漏气的情况。方法：对2007年7月至2015年8月行电视胸腔镜肺叶切除术的5069例患者进行分析。排除标准包括肺叶下切除术或肺切除术、肺切除术合并胸壁或膈切除术、肺套切除术以及术后需要辅助机械通气。漏气时间延长定义为漏气时间超过5天。使用单变量和逻辑回归分析测试了几个基线和手术变量与长时间空气泄漏的可能关联，并通过自举重采样确定。预测因子根据其回归估计按比例加权（给最小系数赋1点）。结果：长时间漏气504例（9.9%）。logistic回归后发现与漏气时间延长相关的三个变量为男性（P < 0.0001，评分= 1）、1秒用力呼气量小于80% （P < 0.0001，评分= 1）、体重指数小于18.5 kg/ m（P < 0.0001，评分= 2）。通过将分配给每个变量的个体得分相加（范围0-4），计算每位患者的总长时间空气泄漏风险评分。将患者按延长漏气风险增量分为4级（P < 0.0001）： A级（0分，1493例）为延长漏气6.3%，B级（1分，2240例）为延长漏气10%，C级（2分，1219例）为延长漏气13%，D级（bbbb2分，117例）为延长漏气25%。结论：建立了一个综合风险评分，对电视胸腔镜肺叶切除术后长时间漏气的发生率进行分层。该评分可用于患者咨询，并确定哪些患者可以从额外的术中预防措施中受益。
Objective: The study objective was to develop an aggregate risk score for predicting the occurrence of prolonged air leak after video-assisted thoracoscopic lobectomy from patients registered in the European Society of Thoracic Surgeons database.Methods: A total of 5069 patients who underwent video-assisted thoracoscopic lobectomy (July 2007 to August 2015) were analyzed. Exclusion criteria included sublobar resections or pneumonectomies, lung resection associated with chest wall or diaphragm resections, sleeve resections, and need for postoperative assisted mechanical ventilation. Prolonged air leak was defined as an air leak more than 5 days. Several baseline and surgical variables were tested for a possible association with prolonged air leak using univariable and logistic regression analyses, determined by bootstrap resampling. Predictors were proportionally weighed according to their regression estimates (assigning 1 point to the smallest coefficient).Results: Prolonged air leak was observed in 504 patients (9.9%). Three variables were found associated with prolonged air leak after logistic regression: male gender (P < .0001, score = 1), forced expiratory volume in 1 second less than 80% (P < .0001, score = 1), and body mass index less than 18.5 kg/ m(2) (P < .0001, score = 2). The aggregate prolonged air leak risk score was calculated for each patient by summing the individual scores assigned to each variable (range, 0-4). Patients were then grouped into 4 classes with an incremental risk of prolonged air leak (P < .0001): class A (score 0 points, 1493 patients) 6.3% with prolonged air leak, class B (score 1 point, 2240 patients) 10% with prolonged air leak, class C (score 2 points, 1219 patients) 13% with prolonged air leak, and class D (score >2 points, 117 patients) 25% with prolonged air leak.Conclusions: An aggregate risk score was created to stratify the incidence of prolonged air leak after video-assisted thoracoscopic lobectomy. The score can be used for patient counseling and to identify those patients who can benefit from additional intraoperative preventative measures.