Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis
Abstract Background Early chest tube removal should be considered to enhance recovery after surgery. The current study aimed to provide a predictive algorithm for air leak episodes (ALE) and to create a knowledge base for early chest tube removal. Methods This retrospective study enrolled patients w...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-024-02620-2 |
| _version_ | 1797259041216397312 |
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| author | Kuniyo Sueyoshi McAndrew Merlini Kosuke Otsubo Fumitsugu Kojima Toru Bando |
| author_facet | Kuniyo Sueyoshi McAndrew Merlini Kosuke Otsubo Fumitsugu Kojima Toru Bando |
| author_sort | Kuniyo Sueyoshi |
| collection | DOAJ |
| description | Abstract Background Early chest tube removal should be considered to enhance recovery after surgery. The current study aimed to provide a predictive algorithm for air leak episodes (ALE) and to create a knowledge base for early chest tube removal. Methods This retrospective study enrolled patients who underwent thoracoscopic anatomical pulmonary resections in our unit. We defined ALE as any airflow ≥ 10 mL/min recorded in the follow-up charts based on the digital thoracic drainage device. Multivariate regression analysis was used to control for preoperative and intraoperative confounding factors. The ALE prediction algorithm was constructed by combining an additive ALE risk-scoring system using the coefficients of the significant predictive factors with the intraoperative water-sealing test. Results In 485 consecutive thoracoscopic major pulmonary resections, ALE developed in 209 (43%) patients. Statistically significant ALE-associated preoperative factors included male sex, lower body mass index, radiologically evident emphysema, lobectomy, and upper lobe surgery. Significant ALE-associated intraoperative factors were incomplete fissure and pleural adhesion. The ALE risk scoring demonstrated an average area under the receiver operating characteristic curve of 0.72 in the fivefold cross-validation test. The ALE prediction algorithm correctly predicted ALE-absent patients at a negative predictive value of 80%. Conclusions The algorithm may promote the optimization of the chest tube-dwelling duration by identifying potential ALE-absent patients for accelerated tube removal. |
| first_indexed | 2024-04-24T23:03:07Z |
| format | Article |
| id | doaj.art-e46797e2d0fc42f39bd396a57479dfa2 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-04-24T23:03:07Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-e46797e2d0fc42f39bd396a57479dfa22024-03-17T12:37:50ZengBMCJournal of Cardiothoracic Surgery1749-80902024-03-011911910.1186/s13019-024-02620-2Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysisKuniyo Sueyoshi0McAndrew Merlini1Kosuke Otsubo2Fumitsugu Kojima3Toru Bando4Department of Thoracic Surgery, St Luke’s International HospitalDepartment of Thoracic Surgery, St Luke’s International HospitalDepartment of Thoracic Surgery, St Luke’s International HospitalDepartment of Thoracic Surgery, St Luke’s International HospitalDepartment of Thoracic Surgery, St Luke’s International HospitalAbstract Background Early chest tube removal should be considered to enhance recovery after surgery. The current study aimed to provide a predictive algorithm for air leak episodes (ALE) and to create a knowledge base for early chest tube removal. Methods This retrospective study enrolled patients who underwent thoracoscopic anatomical pulmonary resections in our unit. We defined ALE as any airflow ≥ 10 mL/min recorded in the follow-up charts based on the digital thoracic drainage device. Multivariate regression analysis was used to control for preoperative and intraoperative confounding factors. The ALE prediction algorithm was constructed by combining an additive ALE risk-scoring system using the coefficients of the significant predictive factors with the intraoperative water-sealing test. Results In 485 consecutive thoracoscopic major pulmonary resections, ALE developed in 209 (43%) patients. Statistically significant ALE-associated preoperative factors included male sex, lower body mass index, radiologically evident emphysema, lobectomy, and upper lobe surgery. Significant ALE-associated intraoperative factors were incomplete fissure and pleural adhesion. The ALE risk scoring demonstrated an average area under the receiver operating characteristic curve of 0.72 in the fivefold cross-validation test. The ALE prediction algorithm correctly predicted ALE-absent patients at a negative predictive value of 80%. Conclusions The algorithm may promote the optimization of the chest tube-dwelling duration by identifying potential ALE-absent patients for accelerated tube removal.https://doi.org/10.1186/s13019-024-02620-2Air leak episodeAnatomical pulmonary resectionEarly chest tube removal |
| spellingShingle | Kuniyo Sueyoshi McAndrew Merlini Kosuke Otsubo Fumitsugu Kojima Toru Bando Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis Journal of Cardiothoracic Surgery Air leak episode Anatomical pulmonary resection Early chest tube removal |
| title | Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis |
| title_full | Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis |
| title_fullStr | Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis |
| title_full_unstemmed | Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis |
| title_short | Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis |
| title_sort | zero leak prediction during major lung resection aiming for minimal chest drainage duration a retrospective analysis |
| topic | Air leak episode Anatomical pulmonary resection Early chest tube removal |
| url | https://doi.org/10.1186/s13019-024-02620-2 |
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