Risk factors for prolonged air leakage after videothoracoscopy: a predictive model

Prolonged air leak (PAL) is one of the most common and serious postoperative complications following video-assisted thoracoscopic surgery (VATS), significantly increasing the risk of secondary diseases and prolonging the recovery period for patients. Considering these consequences, it is crucial to identify key risk factors and develop tools for predicting PAL.

The aim. To determine risk factors for prolonged air leak (PAL) in the postoperative period after video-assisted thoracoscopic surgery (VATS) and to develop a predictive model.

Methods. A retrospective analysis of electronic medical records was performed for patients who underwent VATS at the Department of Thoracic Surgery, University Clinical Hospital No.4, Federal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), between September 2023 and September 2024. The study included demographic, anthropometric, clinical-anamnestic parameters, type of surgical intervention, and preoperative, intraoperative, and postoperative indicators. Univariate and multivariate logistic regression analyses were applied to identify independent predictors of PAL. Model quality was assessed using concordance indices (AUC-ROC), calibration curves, and decision curve analysis (DCA).

Results. The incidence of PAL was 23.6%. Multivariate analysis revealed statistically significant associations of PAL with chronic obstructive pulmonary disease (COPD) (OR = 9.023; 95% CI: 2.129 – 38.240) and the presence of pleural adhesions (OR = 3.404; 95% CI: 1.300 – 8.914). The calibration curve demonstrated good agreement between predicted and actual probabilities, and the area under the ROC curve for the diagnostic model, based on the identified factors, was 0.724 (95% CI: 0.617 – 0.831). A DCA curve was constructed to evaluate the clinical utility of the model. The results showed that the threshold probability ranged from 0.12 to 0.82, and a positive correlation was observed between threshold probability and net benefit of the model at threshold probabilities above 0.12.

Conclusion. COPD and pleural adhesions are risk factors for prolonged air leak after VATS. The developed predictive model demonstrated high accuracy and predictive capability. This model can predict the likelihood of prolonged air leak in patients after VATS. For highrisk patients, preventive measures such as intraoperative use of biological sealants, prolonged pleural drainage, and early respiratory rehabilitation are recommended.

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