WCLC 2018 — Lung resection: postoperative air leakage predicts early readmission in Japanese study

  • Brian Hoyle
  • Univadis
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  • A retrospective analysis has identified prolonged air leakage after lung resection as a predictor of subsequent hospital readmission.

Why this matters

  • Hospital readmission after lung cancer surgery can prelude a bad outcome.
  • Risk factors of unexpected readmission have been examined, but studies were small and findings vary between institutions.
  • More definitive data are necessary.

Study design

  • Single institution study.
  • Retrospective examination of records of patients who underwent lung resection for primary lung cancers from January 2016 through December 2017.
  • Pleural biopsy and unresectable cases excluded.
  • Tumors classified according to the 8th edition of WHO criteria.
  • Unexpected remission defined as unscheduled remission within 30 days after discharge.
  • Unfunded.

Key results

  • 1000 patients; median age, 69 years (range, 32-90 years).
  • 54% men, 46% women.
  • Smoking history: 9% current, 36% never, 55% former.
  • Lung involvement: 61% right, 39% left.
  • Surgery mainly lobectomy (69%), followed by segmentectomy (19%) and wedge resection (11%).
  • Median (range) postoperative stay: 4 (2-117) days.
  • Unexpected readmission for 43 (4.3%) patients.
  • Of those readmitted, 4 (9.3%) died because of exacerbation of interstitial pneumonitis.
  • Univariate analysis comparison of readmitted vs nonreadmitted patients revealed age (P=.002), pack-year smoking (P=.001), diabetes mellitus (P=.022), maximum tumor size (P=.006), clinical nodal status of N0 (P=.039), blood transfusion (P=.017), pneumonia (P<.001 and prolonged postoperative air leakage as predictors of unexpected readmission.>
  • In multivariate analysis, prolonged postoperative air leakage remained a predictor (HR, 3.52; 95% CI, 1.608-7.287; P=.004).

Expert comment

  • "Surgical morbidity and mortality were low and acceptable. Intraoperatively, controlling air leakage will be the most important factor to prevent readmission. Intensive follow-up should be done for patients who have prolonged air leakage," said presenter Shinsuke Uchida, MD, PhD, National Cancer Center Hospital, Tokyo, Japan.