Risk factor analysis and predictive model development for air leakage after thoracoscopic pulmonary wedge resection

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Surgical Outcomes

Background:

• Pulmonary wedge resection is a common procedure with a low rate of major complications.
• Postoperative air leakage (AL) remains a frequent complication following thoracoscopic pulmonary wedge resection.
• Identifying risk factors for AL is crucial for optimizing patient management and exploring alternative surgical strategies.

Purpose of the Study:

• To identify independent risk factors associated with postoperative air leakage (AL) after thoracoscopic pulmonary wedge resection.
• To develop and validate a predictive model for AL to identify patients suitable for tubeless procedures.
• To enhance patient selection for minimally invasive thoracic surgery techniques.

Main Methods:

• Retrospective analysis of 2,503 patients undergoing thoracoscopic pulmonary wedge resection (January 2015 - December 2020).
• Univariate and multivariate logistic regression analyses to determine risk factors for AL.
• External validation of the predictive model using data from two additional centers.

Main Results:

• The overall incidence of AL was 11.35% (284/2,503 patients).
• Key predictors for AL included age >70, reduced forced expiratory volume in 1 second/forced vital capacity ratio (FEV1% <80%), nodule size, tumor benignity/malignancy, and the presence and extent of pleural adhesions.
• The predictive model demonstrated strong performance with a C-index of 0.829 in the development set and 0.833 in the external validation set.

Conclusions:

• The developed AL prediction model is accurate and potentially clinically valuable.
• This model can assist clinicians in assessing the risk of air leakage.
• The model facilitates the identification of suitable candidates for tubeless thoracic surgical procedures, potentially reducing hospital stay and improving patient recovery.