Prolonged air leak after lobectomy and its impact on 30- and 90-day mortality: a retrospective multiple-center study

Objective. To evaluate the impact of PAL on 30- and 90-day mortality and to identify clinical and intraoperative risk factors in patients undergoing anatomical lung resection for malignant tumors. Material and methods. A retrospective multiple-center study included 700 patients who underwent lobectomy between January 2021 and December 2024. PAL was defined as an air leak persisting beyond 5 postoperative days. Univariable and multivariable logistic regression analysis was performed. Results. The incidence of PAL was 15.6%. PAL was significantly associated with longer chest drainage duration (median: 16 vs. 7 days), prolonged hospital-stay (21 vs. 11 days) and higher rates of complications TMM grade II—IIIB (p=0.002). Independent risk factors of PAL were low FEV1 (AOR=0.983), thoracotomy (AOR=2.664) and longer surgery time (AOR=1.009; all p<0.001). PAL was not associated with 30-day mortality but was an independent predictor of 90-day mortality (AOR=2.505; p=0.026). Prognostic model for 90-day mortality showed acceptable accuracy (AUC=0.719). Conclusion. PAL occurred in 15.6% of cases and was associated with prolonged recovery and increased 90-day mortality. Key risk factors were low FEV1, thoracotomy, and longer surgery time.