Risk factors, complications and costs of prolonged air leak after video-assisted thoracoscopic surgery for primary lung cancer.
Risk factors, complications and costs of prolonged air leak after video-assisted thoracoscopic surgery for primary lung cancer.
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DOI：
10.21037/jtd-21-2011
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发表时间：
2023-02-28
影响因子：
2.5
通讯作者：
Augustin, Florian
中科院分区：
文献类型：
--
作者：
Ponholzer, Florian;Ng, Caecilia;Maier, Herbert;Lucciarini, Paolo;Oefner, Dietmar;Augustin, Florian
长时间漏气是肺切除术后常见的并发症。本研究旨在分析PAL发生的危险因素及其对术后预后的影响，并估计额外的治疗费用。我们查询了所有预定接受视频胸腔镜手术治疗原发性肺癌的患者的单中心数据库。2009年至2021年共分析了957名患者。排除标准为全肺切除术。收集的数据包括人口统计学和围手术期数据（如手术时间、术后感染、漏气时间等）。PAL被定义为持续5天或更长时间的空气泄漏。PAL组包括103例患者，非PAL组包括854例患者。进行单因素分析和二项逻辑回归。使用先前出版物中的可用数据进行成本计算，以估计治疗成本。男性、慢性阻塞性肺疾病（COPD）和低体重指数（BMI）是术后PAL发生的危险因素（P<0.001）。利用这些风险因素，建立了PAL的风险预测评分。亚组分析显示，PAL患者的肌肉减少率明显更高（P<0.001）。PAL组的平均胸腔引流持续时间和住院时间（LOS）明显更长（14.2天vs 4.4天，P<0.001； 19.8天vs 9.3天，P<0.001）。PAL患者的手术时间也更长（179.1分钟比161.2分钟，P=0.001）。PAL患者术后感染风险增高[比值比（OR） 3.211, 31.1%比12.3%，P<0.001]。由于LOS时间延长，PAL组的估计治疗费用明显高于非PAL组，根据可获得的费用基础，PAL组的估计治疗费用为2,888.2至12,342.8欧元，而非PAL组的估计治疗费用为1,370.5至5,856.8欧元（P<0.001）。PAL是一种常见的并发症，可延长胸外科手术后的LOS，根据文献，它会导致再入院率升高，导致医疗费用增加。PAL的危险因素已经确定。术前治疗肌肉减少症和不良的营养状况可能会改变风险。由于预防急性呼吸道感染的措施有限，因此需要制定有效管理急性呼吸道感染的指南。
Prolonged air leak (PAL) represents a common complication after lung resection. This study aims to analyze the risk factors for the development of a PAL, its impact on the postoperative outcome and to estimate additional treatment costs. A single center database was queried for all patients scheduled for video-assisted thoracoscopic surgery for primary lung cancer. In total, 957 patients between 2009 and 2021 were analyzed. Exclusion criteria was pneumonectomy. Collected data included demographics and perioperative data (e.g., duration of surgery, postoperative infections, air leak duration etc.). PAL was defined as an air leak lasting for 5 days or longer. The PAL cohort included 103 patients, the non-PAL included 854 patients. Univariate analysis and binomial logistic regression were performed. Cost calculation was performed using available data from prior publications to estimate treatment costs. Male sex, chronic obstructive pulmonary disease (COPD) and low body mass index (BMI) showed to be risk factors for the development of postoperative PAL (P<0.001). Using these risk factors, a risk prediction score for PAL has been established. A subgroup analysis showed a significantly higher rate of sarcopenia in patients with PAL (P<0.001). The mean duration until removal of chest drains and length of stay (LOS) was significantly longer in the PAL cohort (14.2 vs. 4.4 days, P<0.001; 19.8 vs. 9.3 days, P<0.001). Also, the duration of the operation was longer in PAL patients (179.1 vs. 161.2 minutes, P=0.001). Patients with PAL had an elevated risk for postoperative infections [odds ratio (OR) 3.211, 31.1% vs. 12.3%, P<0.001]. As a result of a prolonged LOS, estimated treatment costs were significantly higher for PAL, ranging from 2,888.2 to 12,342.8 € depending on available cost bases compared to the non-PAL cohort, which ranged from 1,370.5 to 5,856.8 € (P<0.001). PAL is a frequent complication that prolongs the LOS after thoracic surgery and, according to the literature, results in elevated readmission rates, leading to excess health care costs. Risk factors for PAL are well established. Preoperative treatment of sarcopenia and dismal nutritional status might alter the risk. As measures to prevent PAL are otherwise limited, guidelines for effective management of PAL need to be established.
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影响因子：
4.6
作者：
Brunelli, Alessandro;Varela, Gonzalo;Luis Aranda, Jose
通讯作者：
Luis Aranda, Jose
影响因子：
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Federico, JA
DOI：
10.1016/j.jtcvs.2018.04.085
发表时间：
2018-09-01
影响因子：
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作者：
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Imperatori, Andrea
影响因子：
4.6
作者：
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Katholi, CR