Risk factor analysis and predictive model development for air leakage after thoracoscopic pulmonary wedge resection

Background: The rate of postoperative complications in wedge resection is low because it does not involve major structures. However, postoperative air leakage (AL) is common. This research sought to determine the risk factors associated with AL following thoracoscopic pulmonary wedge resection and to create a predictive model for identifying patients suitable for tubeless procedures. Methods: This study included individuals who underwent thoracoscopic pulmonary wedge resection at Fujian Medical University Union Hospital from January 2015 to December 2020. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors and construct relevant models. Concurrent data from two other centers were collected as validation sets for external validation. Results: A total of 2,503 patients meeting the inclusion criteria were included in the study, with an overall incidence of AL at 11.35% (284/2,503). The development dataset included 2,006 cases, and columnar plots were drawn based on the outcomes of the multivariate logistic regression analysis. The final model included age >70, forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio (FEV1%) <80%, nodule size, benignity/malignancy, and pleural adhesions (none, focal, diffuse). In the development dataset, the C-index was 0.829. The external validation set included 497 cases, with a C-index of 0.833. Conclusions: The AL prediction model performed well and may be clinically useful for assessing AL and identifying patients who can benefit from tubeless strategies.