|Table of Contents|

Construction and verification of a nomogram model for preoperative prediction of prolonged air leak after anatomic pneumonectomy

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2024 08
Page:
1439-1445
Research Field:
Publishing date:

Info

Title:
Construction and verification of a nomogram model for preoperative prediction of prolonged air leak after anatomic pneumonectomy
Author(s):
MA Shixin1; 2; Wang Lunqing2
1.Dalian Medical University,Liaoning Dalian 116044,China；2.Department of Thoracic Surgery,Qingdao Municipal Hospital,Shandong Qingdao 266071,China.
Keywords:
prolonged air leak (PAL); anatomic pneumonectomy; nomogram model; risk factor
PACS:
R734.2
DOI:
10.3969/j.issn.1672-4992.2024.08.012
Abstract:
Objective:Prolonged air leak (PAL) is one of the most common postoperative complications after lung surgery.This study aimed to identify risk factors for PAL after lung resection and construct a preoperative predictive model to estimate its risk for individual patients.Methods:A retrospective analysis was performed on patients with pulmonary malignancies who underwent anatomic pulmonary resection between January 2017 and June 2021.PAL was defined as air leakage more than 7 days after surgery,and risk factors were analyzed.A multivariate Logistic regression model was used to identify independent risk factors,and a nomogram model was constructed.A bootstrap test with repeated sampling 1 000 times was used to validate the nomogram model internally.The concordance index (C-index) and calibration curve were used to represent the predictive performance and accuracy of the model.Decision curve analysis (DCA) was used to evaluate the clinical application value of this model.Results:A total of 738 patients who met the study criteria were included in the study.The overall incidence of PAL was 8.3%(61/738).Body mass index (BMI),smoking status,duration of surgery,thoracic adhesion,and advanced lung cancer inflammation index (ALI) were included in the final model.The calibration curve showed that the model fits well.The area under curve (AUC) was 0.784 (95%CI:0.720~0.848).DCA results showed that the model had a higher net benefit level.Conclusion:In this study,a nomogram model was established that has good predictive ability and clinical application value for the occurrence of PAL after anatomic pneumonectomy in patients with lung cancer.

References:

［1］SUNG H,FERLAY J,SIEGEL RL,et al.Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries ［J］.CA Cancer J Clin,2021,71(3):209-249.
［2］KNEUERTZ PJ,D'SOUZA DM,RICHARDSON M,et al.Long-term oncologic outcomes after robotic lobectomy for early-stage non-small-cell lung cancer versus video-assisted thoracoscopic and open thoracotomy approach ［J］.Clin Lung Cancer,2020,21(3):214-224.e212.
［3］ZHENG Q,GE L,ZHOU J,et al.Risk factors for prolonged air leak after pulmonary surgery:A systematic review and meta-analysis［J］.Asian J Surg,2022,45(11):2159-2167.
［4］BRUNELLI A,CHAPMAN K,POMPILI C,et al.Ninety-day hospital costs associated with prolonged air leak following lung resection ［J］.Interact Cardiovasc Thorac Surg,2020,31(4):507-512.
［5］JOHNSON BH,JOHNSTON SS,TEWARI P,et al.Clinical and economic burden associated with prolonged air leaks among patients undergoing thoracic resection:a retrospective database analysis ［J］.Clinicoecon Outcomes Res,2023,15:269-280.
［6］LIBERMAN M,MUZIKANSKY A,WRIGHT CD,et al.Incidence and risk factors of persistent air leak after major pulmonary resection and use of chemical pleurodesis ［J］.Ann Thorac Surg,2010,89(3):891-897,discussion 897-898.
［7］REVELO A,KESHISHYAN S,EPELBAUM O,et al.Diagnostic and therapeutic challenges in managing persistent air leaks ［J］.J Thorac Dis,2018,10(1):522-528.
［8］BRUNELLI A,MONTEVERDE M,BORRI A,et al.Predictors of prolonged air leak after pulmonary lobectomy ［J］.Ann Thorac Surg,2004,77(4):1205-1210,discussion 1210.
［9］ELSAYED H,MCSHANE J,SHACKCLOTH M.Air leaks following pulmonary resection for lung cancer:is it a patient or surgeon related problem［J］.Ann R Coll Surg Engl,2012,94(6):422-427.
［10］YOO A,GHOSH SK,DANKER W,et al.Burden of air leak complications in thoracic surgery estimated using a national hospital billing database ［J］.Clinicoecon Outcomes Res,2017,9:373-383.
［11］YOTSUKURA M,OKUBO Y,YOSHIDA Y,et al.Predictive factors and economic impact of prolonged air leak after pulmonary resection ［J］.Gen Thorac Cardiovasc Surg,2022,70(1):44-51.
［12］PETRELLA F,RIZZO S,RADICE D,et al.Predicting prolonged air leak after standard pulmonary lobectomy:computed tomography assessment and risk factors stratification ［J］.Surgeon,2011,9(2):72-77.
［13］BHORA F,GHOSH SK,KASSIS E,et al.Association of tumor location with economic outcomes and air leak complications in thoracic lobectomies:results from a national hospital billing dataset ［J］.Clinicoecon Outcomes Res,2019,11:373-383.
［14］D'ANDRILLI A,ANDREETTI C,IBRAHIM M,et al.A prospective randomized study to assess the efficacy of a surgical sealant to treat air leaks in lung surgery ［J］.Eur J Cardiothorac Surg,2009,35(5):817-821.
［15］MALAPERT G,HANNA HA,PAGES PB,et al.Surgical sealant for the prevention of prolonged air leak after lung resection:meta-analysis ［J］.Ann Thorac Surg,2010,90(6):1779-1785.
［16］BELDA-SANCHIS J,SERRA-MITJANS M,IGLESIAS SENTIS M,et al.Surgical sealant for preventing air leaks after pulmonary resections in patients with lung cancer ［J］.Cochrane Database Syst Rev,2010,2010(1):Cd003051.
［17］GOLOGORSKY RC,ALABASTER AL,ASHIKU SK,et al.Progel use is not associated with decreased incidence of postoperative air leak after nonanatomic lung surgery［J］.Perm J,2019,23:18-59.
［18］MIER JM,MOLINS L,FIBLA JJ.The benefits of digital air leak assessment after pulmonary resection:prospective and comparative study［J］.Cir Esp,2010,87(6):385-389.
［19］GOOSEMAN MR,BRUNELLI A,CHAUDHURI N,et al.Prolonged air leak after segmentectomy:incidence and risk factors ［J］.J Thorac Dis,2023,15(2):858-865.
［20］KONSTANTINIDIS K,WOODCOCK-SHAW J,DINESH P,et al.Incidence and risk factors for 90-day hospital readmission following video-assisted thoracoscopic anatomical lung resection［J］.Eur J Cardiothorac Surg,2019,55(4):666-672.
［21］LITTLETON SW.Impact of obesity on respiratory function ［J］.Respirology,2012,17(1):43-49.
［22］OKADA S,SHIMADA J,KATO D,et al.Prolonged air leak following lobectomy can be predicted in lung cancer patients ［J］.Surg Today,2017,47(8):973-979.
［23］DE WAELE M,AGZARIAN J,HANNA WC,et al.Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?-A prospective randomized trial ［J］.J Thorac Dis,2017,9(6):1598-1606.
［24］PAN H,CHANG R,ZHOU Y,et al.Risk factors associated with prolonged air leak after video-assisted thoracic surgery pulmonary resection:a predictive model and meta-analysis ［J］.Ann Transl Med,2019,7(5):103.
［25］LEE L,HANLEY SC,ROBINEAU C,et al.Estimating the risk of prolonged air leak after pulmonary resection using a simple scoring system ［J］.J Am Coll Surg,2011,212(6):1027-1032.
［26］DALEY BJ,CECIL W,CLARKE PC,et al.How slow is too slow? Correlation of operative time to complications:an analysis from the Tennessee Surgical Quality Collaborative ［J］.J Am Coll Surg,2015,220(4):550-558.
［27］DEXTER E,ATTWOOD K,DEMMY T,et al.Does operative duration of lobectomy for early lung cancer increase perioperative morbidity［J］.Ann Thorac Surg,2022,114(3):941-947.

Memo

Memo:
-
Last Update: 1900-01-01