Risk factors for extensive subcutaneous emphysema after pulmonary resection by video-assisted thoracoscopic surgery: a case-control study

Introduction
Extensive subcutaneous emphysema may lead to a significantly prolonged hospital stay, cosmetic problems, and even death without timely treatment. However, the risk factors for it have been poorly studied.

Aim
To clarify the prevalence and risk factors of extensive subcutaneous emphysema after pulmonary resection by video-assisted thoracoscopic surgery.

Material and methods
This is a retrospective matched case-control study. A sample of 86 cases and 258 matched controls was recruited from among 4339 patients admitted to the thoracic surgery department from October 2018 to October 2020 in a tertiary teaching hospital in China. Cases were patients who were diagnosed with extensive subcutaneous emphysema after pulmonary resection through video-assisted thoracoscopic surgery. Controls were matched in a ratio of 3 : 1 to the cases based on age and sex.

Results
In this study, the incidence rate of extensive subcutaneous emphysema was 2.05%, and approximately 75.58% of the cases occurred within 1 to 4 days postoperatively. In univariate analysis, patients with extensive subcutaneous emphysema were also likely to have a significant lower body mass index, worse pulmonary function, greater intraoperative blood loss, longer time of operation, history of lung surgery, wider scope of surgery, and more extensive pleural adhesion. The results of multivariate logistic regression showed that segmentectomy (OR = 3.130, 95% CI: 1.055–9.283, p = 0.040), lobectomy (OR = 4.487, 95% CI: 1.704–11.812, p = 0.002), and extensive pleural adhesion (OR = 4.514, 95% CI: 1.763–11.556, p = 0.002) were independent risk factors.

Conclusions
Segmentectomy, lobectomy, and extensive pleural adhesions were identified as independent risk factors for extensive subcutaneous emphysema after video-assisted thoracoscopic surgery.