A Scoring System to Predict the Risk of Prolonged Air Leak After Lobectomy
A Scoring System to Predict the Risk of Prolonged Air Leak After Lobectomy
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DOI：
10.1016/j.athoracsur.2010.02.054
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发表时间：
2010-07-01
影响因子：
4.6
通讯作者：
Luis Aranda, Jose
中科院分区：
文献类型：
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作者：
Brunelli, Alessandro;Varela, Gonzalo;Luis Aranda, Jose
背景。长时间的漏气（PAL）仍然是肺切除术后常见的并发症。围手术期的预防策略已经被测试过，但由于不同的纳入标准，它们的疗效往往难以解释。本研究的目的是开发和验证一种实用的评分方法，以对肺叶切除术后PAL的风险进行分层。在A中心，658名连续患者接受肺叶切除术（2000 - 2008），并用于制定预测PAL发生率的风险调整评分（bbb50天）。排除标准为胸壁切除和术后辅助机械通气。没有使用密封剂、胸膜帐篷或支撑材料。采用受试者工作曲线分析对数值变量进行分类，建立总评分。通过单因素分析筛选变量，然后进行逐步逻辑回归分析（bootstrap验证）。评分系统是通过对显著预测因子估计的比例加权来开发的，并在不同中心的手术患者中进行了验证（中心B）。结果。衍生集PAL的发生率为13%（658例中有87例）。预测变量及其得分为：年龄大于65岁（1分）；存在胸膜粘连（1点）；用力呼气量1秒内小于80%（1.5分）；且身体质量指数小于25.5 kg/m(2)（2分）。根据患者的总得分将患者分为4个风险等级，在233例患者的验证集中，风险等级与PAL的增量风险显著相关。开发的评分系统可靠地预测肺叶切除术后PAL的增量风险。它的使用可能有助于识别那些高危患者采取术中预防策略；为未来旨在减少或防止空气泄漏的新技术的随机临床试验制定纳入标准；也为病人提供咨询。（Ann Thorac surgery 2010;90:204-9） (C) 2010年由胸外科医师协会出版
Background. Prolonged air leak (PAL) remains a frequent complication after lung resection. Perioperative preventative strategies have been tested, but their efficacy is often difficult to interpret due to heterogeneous inclusion criteria. The objective of this study was to develop and validate a practical score to stratify the risk of PAL after lobectomy.Methods. Six hundred fifty-eight consecutive patients were submitted to pulmonary lobectomy (2000 to 2008) in center A and were used to develop the risk-adjusted score predicting the incidence of PAL (> 5 days). Exclusion criteria were chest wall resection and postoperative assisted mechanical ventilation. No sealants, pleural tent, or buttressing material were used. To build the aggregate score numeric variables were categorized by receiver operating curve analysis. Variables were screened by univariate analysis and then used in stepwise logistic regression analysis (validated by bootstrap). The scoring system was developed by proportional weighing of the significant predictor estimates and was validated on patients operated on in a different center (center B).Results. The incidence of PAL in the derivation set was 13% (87 of 658 cases). Predictive variables and their scores were the following: age greater than 65 years (1 point); presence of pleural adhesions (1 point); forced expiratory volume in one second less than 80% (1.5 points); and body mass index less than 25.5 kg/m(2) (2 points). Patients were grouped into 4 risk classes according to their aggregate scores, which were significantly associated with incremental risk of PAL in the validation set of 233 patients.Conclusions. The developed scoring system reliably predicts incremental risk of PAL after pulmonary lobectomy. Its use may help in identifying those high-risk patients in whom to adopt intraoperative prophylactic strategies; in developing inclusion criteria for future randomized clinical trials on new technologies aimed at reducing or preventing air leak; and for patient counseling. (Ann Thorac Surg 2010;90:204-9) (C) 2010 by The Society of Thoracic Surgeons