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Ann Thorac Surg 2006;82:197-207
© 2006 The Society of Thoracic Surgeons
a Section of Thoracic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
b Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
c Department of Quantitative Health Sciences, The Cleveland Clinic Foundation, Cleveland, Ohio
d Department of Pulmonary, Allergy, and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio
e Division of Cardiothoracic Surgery, St. Louis University Health Sciences Center, St. Louis, Missouri
f Thoracic Surgery Division, University of Maryland Medical Center, Baltimore, Maryland
g Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
h Center for Chest Diseases, Cedars-Sinai Medical Center, Los Angeles, California
Accepted for publication February 22, 2006.
* Address correspondence to Dr DeCamp, Beth Israel Deaconess Medical Center, 110 Francis Street Suite A, Boston, MA 02215 (Email: mdecamp{at}bidmc.harvard.edu).
Presented at the Fifty-first Annual Meeting of the Southern Thoracic Surgical Association, Cancun, Mexico, Nov 2–4, 2004.
BACKGROUND: Although staple line buttressing is advocated to reduce air leak after lung volume reduction surgery (LVRS), its effectiveness is unknown. We sought to identify risk factors for air leak and its duration and to estimate its medical consequences for selecting optimal perioperative technique(s), such as buttressing technique, to preempt or treat post-LVRS air leak.
METHODS: Detailed air leak data were available for 552 of 580 patients receiving bilateral stapled LVRS in the National Emphysema Treatment Trial. Risk factors for prevalence and duration of air leak were identified by logistic and hazard function analyses. Medical consequences were estimated in propensity-matched pairs with and without air leak.
RESULTS: Within 30 days of LVRS, 90% of patients developed air leak (median duration = 7 days). Its occurrence was more common and duration prolonged in patients with lower diffusing capacity (p = 0.06), upper lobe disease (p = 0.04), and important pleural adhesions (p = 0.007). Duration was also protracted in Caucasians (p < 0.0001), patients using inhaled steroids (p = 0.004), and those with lower 1-second forced expiratory volume (p = 0.0003). Surgical approach, buttressing, stapler brand, and intraoperative adjunctive procedures were not associated with fewer or less prolonged air leaks (p 
0.2). Postoperative complications occurred more often in matched patients experiencing air leak (57% vs 30%, p = 0.0004), and postoperative stay was longer (11.8 ± 6.5 days vs 7.6 ± 4.4 days, p = 0.0005).
CONCLUSIONS: Air leak accompanies LVRS in 90% of patients, is often prolonged, and is associated with a more complicated and protracted hospital course. Its occurrence and duration are associated with characteristics of patients and their disease, not with a specific surgical technique.
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