Incidence and Risk Factors of Prolonged Air Leak After Pulmonary Lobectomy: A Prospective Observational Study

Abstract

Objective: To determine the incidence of prolonged air leak after pulmonary lobectomy and identify independent risk factors in an Iraqi tertiary care center.

Study Design: prospective observational study
Place and Duration of Study: This study was conducted at the Nasiriyah Teaching Hospital Iraq from 1st February 2023 to 31st January 2025.

Methods: Prolonged air leak was defined as persistent asthmatic gas leak for ≥7 days postoperatively. Perioperative data were extracted including demographics, comorbidities, surgical approach, intraoperative factors and
postoperative outcomes. Independent risk factors for prolonged air leak were identified using multivariable logistic regression analysis.

Results: Overall prolonged air leak incidence in 54 (18.1%) patients. Mean age was 58.7±12.4 years, comprising 62.4% males. Right upper lobectomy was performed most often (34.2%). Independent risk factors for prolonged air leak were: older age (OR 1.04, 95% CI 1.01-1.07, p=0.008), chronic obstructive pulmonary disease (OR 2.89, 95% CI 1.45-5.76, p=0.003), need for adhesiolysis (OR 3.21, 95% CI 1.68-5.76, p<0.001), incomplete fissure (OR 2.45, 95 prolonged air leak patients had significantly longer hospital stay (12.8 vs 6.2 days, p<0.001) and readmission rates (22.2% vs 4.9%, p<0.001).

Conclusion: Prolonged air leak incidence after lobectomy in our Iraqi population aligns with international rates. Identified risk factors enable enhanced preoperative counselling and targeted preventive strategies, potentially improving patient outcomes and reducing healthcare burden in resource-limited settings.