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Eur J Cardiothorac Surg 2005;27:329-333
© 2005 Elsevier Science NL
Section of Thoracic Surgery, Salamanca University Hospital, 37007 Salamanca, Paseo de San Vicente 58, Spain
Received 20 August 2004; received in revised form 3 November 2004; accepted 8 November 2004.
* Corresponding author. Tel./fax: +34 923 291 383. (E-mail: gvs{at}usal.es).
Objective: Prolonged air leak (PAL) after pulmonary surgery is a
frequent occurrence and is reported to cause increased length of stay (LOS)
and hospital costs although the costs directly attributable to PAL have
never been published. The present study aims to compare the prevalence of
pulmonary complications (atelectasis, pneumonia and pleural empyema) in
patients with or without PAL and to quantify economic costs directly
incurred by PAL in a series of pulmonary lobectomies. Methods: A
series of 238 patients scheduled for pulmonary lobectomy (January
2001–December 2003) have been reviewed. PAL was defined as air
leakage which prevented hospital discharge for 5 postoperative days or
over. Hospital costs (excluding operating room) for pulmonary lobectomies
have been obtained and calculated as mean daily costs. Age, body mass
index, diagnosis, Charlson co-morbidity index, ppoFEV1 and major
post-operative cardio-pulmonary morbidity have been used to construct a
Cox-regression model for hospital stay, considering deaths as censored
cases. Individual risk function has been used as a new variable and
expected LOS calculated for each case. This data has been used to estimate
total excess hospital stay and costs incurred by cases with PAL.
Results: Prevalence of PAL was 23 cases (9, 7%). Mean daily hospital
cost for lobectomy was 632.49
. For the whole series, mean hospital
stay was 5 days (10 days for patients with PAL). PAL cases had more
postoperative pulmonary morbidity (risk-ratio: 2.78). Variables showing
independent influence on stay were: diagnosis of non-malignant disease
(P=0.001); FEV1ppo (P=0.032) and
cardio-respiratory morbidity (P<0.001). Calculated total excess
stay for PAL patients was 62 days. A total expense of 39,437.39
(38,724.96 hospital and 712.43 pharmacy charges) were estimated
to result from postoperative air-leak. Conclusions: PAL patients are
prone to developing major postoperative morbidity. PAL calculated costs are
over 13000 per year. This data is useful for designing technical cost-effective strategies to avoid post-lobectomy PAL.
Key Words: Lung resection • Adverse outcomes • Postoperative air-leak • Hospital costs
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