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Pneumothorax-II01:27

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Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
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Relative risk (RR) is a statistical measure commonly used in epidemiology to compare the likelihood of a particular event occurring between two groups. This metric is important for evaluating the relationship between exposure to a specific risk factor and the probability of a particular outcome. It plays a crucial role in medical research, public health studies, and risk assessment. Relative risk quantifies how much more (or less) likely an event is to occur in an exposed group compared to an...
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Which Risk Score Best Predicts Prolonged Air Leak After Lobectomy? A Comparative Evaluation Study.

Yuki Shindo1, Satoshi Fumimoto1, Nobuharu Hanaoka1

  • 1Department of Thoracic and Cardiovascular Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka 569-8686, Japan.

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Summary
This summary is machine-generated.

Prolonged air leak (PAL) after lung surgery is common. The Epithor score showed the best overall performance in predicting PAL, but combining scores may improve risk assessment.

Keywords:
Epithor scorePALSlobectomylung cancerprolonged air leakvideo-assisted thoracoscopic surgery

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Area of Science:

  • Thoracic Surgery
  • Pulmonary Medicine
  • Surgical Outcomes Research

Background:

  • Prolonged air leak (PAL) is a frequent complication after pulmonary resection, leading to increased patient morbidity, longer hospital stays, and higher healthcare costs.
  • Existing scoring systems aim to predict PAL, but their clinical validation and comparative performance require further investigation.

Purpose of the Study:

  • To compare the predictive performance of three established scoring systems—the Epithor score, Gilbert score, and prolonged air leak score (PALS)—for PAL in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy.
  • To identify independent predictors of PAL within this specific surgical cohort.

Main Methods:

  • A retrospective analysis of 534 patients who underwent VATS single-lobe lobectomy for primary lung cancer between 2012 and 2021.
  • PAL was defined as an air leak persisting for more than 5 days postoperatively.
  • Model performance was evaluated using discrimination metrics (AUC, calibration plots, Hosmer-Lemeshow test, Brier score) and clinical utility assessed via decision curve analysis (DCA).

Main Results:

  • The incidence of PAL was 9.9% (53 patients). Independent risk factors identified included male sex, body mass index <25.5 kg/m², and the presence of pleural adhesions.
  • The Epithor score demonstrated the highest discrimination (AUC = 0.735), while PALS showed the most accurate calibration.
  • Decision curve analysis indicated that Epithor offered the greatest net benefit at low probability thresholds, Gilbert at mid-range thresholds, and PALS across typical clinical ranges.

Conclusions:

  • In this single-center cohort, the Epithor score exhibited the best overall predictive performance for PAL following VATS lobectomy.
  • PALS provided superior threshold-specific calibration and clinical utility.
  • Combining the Epithor and PALS may enhance individualized risk stratification for PAL, though definitive superiority of any single model was not established.