Department of Cardiothoracic Surgery, Division of Thoracic and Foregut Surgery, Pittsburgh, PA.
Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA.
Ann Surg. 2021 Jan 1;273(1):163-172. doi: 10.1097/SLA.0000000000003191.
The aim of the study was to determine whether prolonged air leak (PAL) is associated with postoperative morbidity and mortality following pulmonary resection after adjusting for differences in baseline characteristics using propensity score analysis.
Patients with PAL after lung resection have worse outcomes than those without PAL. However, adverse postoperative outcomes may also be secondary to baseline risk factors, such as poor lung function.
Patients who underwent pulmonary resection for lung cancer/nodules (1/2009-6/2014) were stratified by the presence of PAL [n = 183 with/1950 without; defined as >5 d postoperative air leak; n = 189 (8.3%)]; probability estimates for propensity for PAL from 31 pretreatment/intraoperative variables were generated. Inverse probability-of-treatment weights were applied and outcomes assessed with logistic regression.
Standardized bias between groups was significantly reduced after propensity weighting (mean = 0.18 before vs 0.08 after, P < 0.01). After propensity weighting, PAL was associated with increased odds of empyema (OR = 8.5; P < 0.001), requirement for additional chest tubes for pneumothorax (OR = 7.5; P < 0.001), blood transfusion (OR = 2; P = 0.03), pulmonary complications (OR = 4; P < 0.001), unexpected return to operating room (OR = 4; P < 0.001), and 30-day readmission (OR = 2; P = 0.009). Among other complications, odds of cardiac complications (P = 0.493), unexpected ICU admission (P = 0.156), and 30-day mortality (P = 0.270) did not differ. Length of hospital stay was prolonged (5.04 d relative effect, 95% confidence interval, 3.77-6.30; P < 0.001).
Pulmonary complications, readmission, and delayed hospital discharge are directly attributable to having a PAL, whereas cardiac complications, unexpected admission to the ICU, and 30-day mortality are not after propensity score adjustment.
本研究旨在通过倾向评分分析，在调整基线特征差异后，确定延长的气漏（PAL）与肺切除术后的发病率和死亡率是否相关。
肺切除术后发生 PAL 的患者比无 PAL 的患者预后更差。然而，术后不良结局也可能继发于基线风险因素，如肺功能差。
根据 PAL 的存在情况（183 例有/1950 例无；定义为术后 >5 d 漏气；n = 189（8.3%）），对 2009 年 1 月至 2014 年 6 月接受肺癌/结节肺切除术的患者进行分层；从 31 个术前/术中变量中生成 PAL 发生可能性的倾向评分估计值。应用逆概率治疗权重，并通过逻辑回归评估结局。
在进行倾向评分加权后，组间标准化偏差显著降低（平均=0.18 术前 vs 0.08 术后，P < 0.01）。在进行倾向评分加权后，PAL 与脓胸（比值比 [OR] = 8.5；P < 0.001）、气胸需额外放置胸腔引流管（OR = 7.5；P < 0.001）、输血（OR = 2；P = 0.03）、肺部并发症（OR = 4；P < 0.001）、意外返回手术室（OR = 4；P < 0.001）和 30 天再入院（OR = 2；P = 0.009）的发生风险增加相关。在其他并发症中，发生心脏并发症的风险（P = 0.493）、意外入住 ICU（P = 0.156）和 30 天死亡率（P = 0.270）无差异。住院时间延长（相对效应 5.04 d，95%置信区间 3.77-6.30；P < 0.001）。
肺并发症、再入院和延迟出院可直接归因于 PAL 的发生，而心脏并发症、意外入住 ICU 和 30 天死亡率在进行倾向评分调整后则不是。
