{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T12:09:21Z","timestamp":1747224561537,"version":"3.40.5"},"reference-count":20,"publisher":"PAGEPress Publications","license":[{"start":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T00:00:00Z","timestamp":1674691200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Monaldi Arch Chest Dis"],"abstract":"<jats:p>Persistent alveolar air leak (PAAL) after major lung resection remains a common complication in thoracic surgery. The aim of this study was to identify a subset of patients with high risk of developing PAAL after pulmonary lobectomy. Another objective was to evaluate the influence of PAAL on postoperative complications and length of hospital stay. A retrospective analysis on 895 patients undergoing pulmonary lobectomy from January 2014 to December 2019 was performed. PAAL was defined as air leak lasting more than 5 days after lung surgery. Univariate analyses and logistic regressions were performed to identify the predictors of PAAL. A backward selection algorithm was used to identify the optimal set of predictors. The incidence of PAAL was 8.2% (74\/895). Male gender (p=0.017), BMI (p&lt;0.001), transient ischemic attack (p=0.031), FEV1 (p=0.018), lobectomy combined with adjacent subsegmentectomy (p=0.018), partial and extended pleural adhesions (p=0.033 and p=0.038, respectively) were identified as independent risk factors for PAAL through logistic regression. A weak positive correlation was found between video-assisted thoracic surgery (VATS) and PAAL following pulmonary lobectomy (p=0.100). PAAL was found to be associated with higher risk of postoperative morbidity (p=0.002) and with longer hospital stay (p&lt;0.001). Both preoperative and intraoperative risk factors may be responsible for PAAL after pulmonary lobectomy. VATS does not appear to prevent this postoperative complication. An alveolar air leak lasting beyond 5 days after pulmonary lobectomy is associated with worse postoperative outcomes.\n\u00a0<\/jats:p>","DOI":"10.4081\/monaldi.2023.2474","type":"journal-article","created":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T14:47:33Z","timestamp":1674744453000},"source":"Crossref","is-referenced-by-count":0,"title":["Persistent alveolar air leak following pulmonary lobectomy: an old problem in a modern era"],"prefix":"10.4081","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9667-8315","authenticated-orcid":false,"given":"Dario","family":"Amore","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umberto","family":"Caterino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dino","family":"Casazza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Ievoli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pasquale","family":"Imitazione","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Saglia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Izzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Rispoli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Curcio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2023,1,26]]},"reference":[{"key":"24231","doi-asserted-by":"crossref","unstructured":"Cerfolio RJ. Early postoperative complications. In: Patterson GA, Cooper JD, Deslauriers J, et al. editors. Pearson\u2019s Thoracic & Esophageal Surgery 3rded. Churchill Livingstone, Philadelphia: 2008. pp. 160-165.","DOI":"10.1016\/B978-0-443-06861-4.50016-2"},{"key":"24232","doi-asserted-by":"crossref","unstructured":"Varela G, Jim\u00e8nez MF, Novoa N, Aranda JL. Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy. Eur J Cardiothorac Surg 2005;27:329-33.","DOI":"10.1016\/j.ejcts.2004.11.005"},{"key":"24233","doi-asserted-by":"crossref","unstructured":"Keagy BA, Lores ME, Starek PJ, et al. Elective pulmonary lobectomy: factors associated with morbidity and operative mortality. Ann Thorac Surg 1985;40:349-52.","DOI":"10.1016\/S0003-4975(10)60065-3"},{"key":"24234","doi-asserted-by":"crossref","unstructured":"Zhao K, Mei J, Xia C, et al. 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A risk score to predict the incidence of prolonged air leak after video-assisted thoracoscopic lobectomy: an analysis from the European Society of Thoracic Surgeons database. J Thorac Cardiovasc Surg 2017;153:957-65.","DOI":"10.1016\/j.jtcvs.2016.11.064"},{"key":"24243","doi-asserted-by":"crossref","unstructured":"Rivera C, Bernard A, Falcoz PE, et al. Characterization and prediction of prolonged air leak after pulmonary resection: a nationwide study setting up the index of prolonged air leak. Ann Thorac Surg 2011;92:1062-8.","DOI":"10.1016\/j.athoracsur.2011.04.033"},{"key":"24244","doi-asserted-by":"crossref","unstructured":"Lee L, Hanley SC, Robineau C, et al. Estimating the risk of prolonged air leak after pulmonary resection using a simple scoring system. J Am Coll Surg 2011;212:1027-32.","DOI":"10.1016\/j.jamcollsurg.2011.03.010"},{"key":"24245","doi-asserted-by":"crossref","unstructured":"Viti A, Socci L, Congregado M, et al. The everlasting issue of prolonged air leaks after lobectomy for non-small cell lung cancer: A data-driven prevention planning model in the era of minimally invasive approaches. J Surg Oncol 2018;118:1285-91.","DOI":"10.1002\/jso.25289"},{"key":"24246","doi-asserted-by":"crossref","unstructured":"Elsayed H, McShane J, Shackcloth M. Air leaks following pulmonary resection for lung cancer: is it a patient or surgeon related problem? Ann R Coll Surg Engl 2012;94:422-7.","DOI":"10.1308\/003588412X13171221592258"},{"key":"24247","doi-asserted-by":"crossref","unstructured":"Okereke I, Murthy SC, Alster JM, et al. Characterization and importance of air leak after lobectomy. Ann Thorac Surg 2005;79:1167-73.","DOI":"10.1016\/j.athoracsur.2004.08.069"},{"key":"24248","doi-asserted-by":"crossref","unstructured":"Bardell T, Petsikas D. What keeps postpulmonary resection patients in hospital? 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