Risk factors predisposing to prolonged air leak after video-assisted thoracoscopic surgery for spontaneous pneumothorax.

Background. The goal of this prospective study was to determine risk factors for prolonged air leak (PAL) for patients who underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. Methods. Between January 2002 and June 2012, a total of 2,292 patients were eligible for enrollment in the study: 1,800 patients had primary spontaneous pneumothorax and 492 patients had secondary spontaneous pneumothorax. There were 312 female and 1,980 male patients with a mean age of 41 years (range, 13 to 85 years). Twenty-three variables were recorded for each patient. The primary endpoint was rate of postoperative PAL (chest tube drainage for >7 days). Statistical evaluation used univariate and multivariate logistic regression analyses. Results. A total of 223 (9.73%) cases of postoperative PAL occurred in 2,292 patients. Comparing clinical characteristics between the patients with and without PAL, mean age in the air leak group (59 +/- 18 y) was significantly older than that in non-air-leak group (39 +/- 18 y) (p < 0.05). Multivariate analyses found 4 variables related to PAL (p < 0.05): age, American Society of Anesthesiologists scores, bilateral procedures, and bullae diameter. No significant relationships were found between pleural abrasions and/or talc pleurodesis and PAL. Conclusions. Prolonged air leak is one of the most common complications after spontaneous pneumothorax operations. Age, American Society of Anesthesiologists scores, bilateral procedures, and bullae diameter were risk factors for PAL. Use of talc pleurodesis with pleural abrasion may not decrease the incidence of PAL in VATS spontaneous pneumothorax operation. Talc pleurodesis with pleural abrasion should be used cautiously in patients with significant comorbid conditions or advanced age. (C) 2014 by The Society of Thoracic Surgeons