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Routine Use of Intraoperative Pleural Air Sealant in Minimally Invasive Lung Resections: a Single-Surgeon Analysis
*Samih Shafique MS, *Benjamin Palleiko BS, *Tanmay Patil MPH, *Allison Crawford MS, *Isabel Cristina M. Emmerick , Feiran Lou MD, Karl F. Uy MD, Mark W. Maxfield MD
Department of Surgery, Division of Thoracic Surgery, University Of Massachusetts Chan Medical School, Worcester, MA

Background: While pleural sealants are approved for the control of intraoperative air leaks in thoracic surgery, their routine use has not been widely considered. This study examines the impact of routine pleural air leak sealant on chest tube duration and hospital stay following minimally invasive lung resections performed by a single surgeon.
Study Design: A single-center, single-surgeon retrospective review of patients who underwent minimally invasive lung resections (lobectomy, segmentectomy, and wedge) and had pleural air leak sealant applied from 9/3/2020 to 12/18/2023, representing all patients who underwent minimally invasive lung resections in that period. Primary outcomes were chest tube duration and hospital length of stay (LOS). Patients who received pleural sealant were compared to sequential historical controls (9/11/2018 to 8/21/2020) who had no pleural sealant applied. Univariate analysis compared means utilizing a two-sample t-test and medians were compared with nonparametric testing. An ANCOVA analysis was conducted to control for predetermined, clinically relevant variables such as the implementation of enhanced recovery after surgery (ERAS) protocols, BMI, smoking status, FEV1, and the use of digital chest drainage systems.
Results: 186 patients had pleural sealant (PS) applied and 58 did not receive PS intraoperatively. Median chest tube durations were reduced in the PS group compared to historical controls (2 days vs 3 days, respectively, p=0.004). There was no significant difference in median LOS between PS and control groups (p=0.30). In the ANCOVA model overall, neither chest tube duration nor hospital LOS showed significant difference with PS intervention (p=0.71 and p=0.38, respectively). When stratified by resection type, there was a statistically significant reduction in chest tube duration with routine pleural sealant application in the setting of wedge resections as predicted by the ANCOVA model (p=0.004) as well as a reduction in LOS, which is nearing statistical significance (p=0.07). The model did not predict significantly reduced chest tube duration or LOS in the setting of anatomic resections (p=0.40 and p=0.10, respectively).
Conclusions: Data suggests the routine use of pleural sealants may have a role in reducing air leaks and removing chest tubes earlier. Multivariate analysis in the setting of wedge resections demonstrates a statistically significant reduction in chest tube duration with routine pleural sealant application. Future analyses with increased power should be conducted to inform the extent to which pleural sealants may benefit in this setting.
Chest Tube Duration and Hospital LOS in Pleural Sealant Group vs. Controls
 Control Group
n=58
Pleaural Sealant Group
n=186
p value
All patients (n=244)
Chest Tube Duration (days):
   
Mean3.03.00.98
Median (IQR)3.0 (1.0 - 4.0)2.0 (1.0 - 3.0)0.004
ANCOVA Model  0.71
Hospital Length of Stay (days):   
Mean4.14.20.81
Median (IQR)3.0 (3.0 - 5.0)3.9 (2.0 - 5.0)0.30
ANCOVA Model  0.38
Anatomic Resections (n=187)
Chest Tube Duration (days):
   
Mean3.13.30.73
Median (IQR)3.0 (1.5 - 4.5)2.0 (1.0 - 3.0)0.033
ANCOVA Model  0.40
Hospital Length of Stay (days):   
Mean4.04.60.22
Median (IQR)3.0 (2.5 - 5.0)3.0 (2.0 - 6.0)0.81
ANCOVA Model  0.10
Wedge Resections (n=57)
Chest Tube Duration (days):
   
Mean2.52.00.34
Median (IQR)2.0 (1.0 - 3.0)1 (1.0 - 2.0)0.027
ANCOVA Model  0.004
Hospital Length of Stay (days):   
Mean4.42.90.24
Median (IQR)3.0 (3.0 - 4.0)2.0 (2.0 - 3.0)0.09
ANCOVA Model  0.07


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