Prolonged air leak after video-assisted thoracic surgery lung cancer resection: risk factors and its effect on postoperative clinical recovery

Background: Prolonged air leak (PAL) is one of the most common postoperative complications after pulmonary resection. The aim of this study was to reveal the incidence and risk factors of PAL in video-assisted thoracic surgery (VATS) lung cancer resection, and to evaluate the effect of PAL on postoperative complications, postoperative length of stay (PLOS), and medical costs. Methods: Continuous patients who underwent VATS major pulmonary resection for lung cancer between January 2014 and December 2015 were studied. Clinical data of these patients were obtained from the Western China Lung Cancer Database. PAL was defined as air leak more than 5 days after surgery. The risk factors for PAL were analyzed, as well as the effect of PAL on postoperative clinical recovery. Results: A total of 1,051 patients were enrolled in this study. The incidence of PAL was 10.6% (111/1,051). Pleural adhesion [odds ratio (OR), 2.38 for extensive vs. none, P=0.001] was identified as the only independent risk factors for PAL through multivariate analysis. The incidence of overall complications and pneumonia were significantly higher in patients with PAL (PAL group) than those without PAL (non-PAL group) (OR, 6.77, P=0.000; OR, 2.41, P=0.010, respectively). PAL was found to be associated with longer PLOS (11.7 +/- 6.6 vs. 6.5 +/- 3.6 days; P=0.000) and higher medical costs ((sic)62,042.5 +/- 18,072.0 vs.(sic)52,291.3 +/- 13,845.5, P=0.000). Conclusions: Pleural adhesion was associated with increased risk of PAL after VATS lung cancer resection. Those patients with PAL had more postoperative complications, stayed longer in the hospital after surgery, and paid higher medical costs.