R. Gerard2, R. Patel2, D. Nguyen2, F. Velez-Cubian2, C. Moodie1, J. Garrett1, J. Fontaine1,2, E. Toloza1,2 1Moffitt Cancer Center And Research Institute,Tampa, FL, USA 2University Of South Florida College Of Medicine,Tampa, FL, USA
Introduction: Prolonged air leak (PAL) is the most common complication following partial lung resection and an important determinant of hospital length of stay (LOS). This study sought to identify risk factors for developing PAL after robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy.
Methods: We retrospectively analyzed prospectively-collected data from patients who underwent RAVT lobectomy by one surgeon between September 2010 and May 2017. Patients were grouped based on having or not having PAL, defined as an air leak persisting >5 days, during the postoperative period. Patients’ demographics, intraoperative complications, perioperative outcomes, and postoperative complications were compared.
Results: Of 423 total patients who underwent RAVT lobectomy, 89 patients (21%) experienced PAL. Patients with PAL had lower mean body mass index (BMI) compared to patients with no PAL (26.9 kg/m2 vs. 28.7 kg/m2, p=0.045). Patients who developed PAL postoperatively were more likely to have chronic obstructive pulmonary disease (COPD) (33% vs. 16%, p<0.001) or history of previous pneumonia (14% vs. 7%, p=0.045). Patients with PAL had lower pre-operative forced expiratory volume in 1 second as percent of predicted (preopFEV1%) (81.2% vs. 87.4%, p=0.010). Patients with repeat pulmonary surgery were more likely to experience PAL postoperatively, with 50% of those 14 patients developing PAL. Patients who had intraoperative tracheobronchial injury were also at higher risk for PAL (p=0.032). Patients with PAL experienced greater median estimated-blood-loss (EBL) (200 mL vs. 150 mL, p=0.013) and greater median operative time (208 min vs. 172 min, p=0.001). Patients with PAL had longer median hospital LOS (9 d vs. 4 d, p<0.001).
Conclusion: Decreased BMI, decreased preopFEV1%, COPD, previous pneumonia, re-do surgery, and intraoperative bronchial injury were identified as being risk factors for the development of PAL during the postoperative period. These patients also experienced increased EBL, operative time, and had longer hospital LOS.