Role of the Goddard Score in Predicting Prolonged Air Leak in Pulmonary Segmentectomies

Abstract

Background

Prolonged air leak (PAL) is a major cause of morbidities and increased treatment costs following lung resection. The Goddard score (GS) quantifies pulmonary emphysema on computed tomography, a risk factor for PAL, from 0 to 24.

Methods

We evaluated the GS as a predictor of PAL in pulmonary segmentectomies by retrospectively analyzing 131 patients with anatomical segmentectomy. We identified predictors of PAL and performed logistic regression.

Results

Eighty-three percent of patients had a history of smoking. The mean air leak duration was 4.2 days; 16% had PAL (>7 days). Median GS was 1. The optimal cutoff was GS ≥ 6 (area under the curve AUC = 0.625). GS did not correlate with air leak duration. In combination, body mass index, cumulative pack-years, immunosuppression, adhesiolysis, operation time, and GS ≥ 6 best predicted PAL with AUC = 0.914. Omitting GS still leads to an AUC = 0.864.

Conclusion

The GS does not add enough information to be of practical value in anatomic segmentectomies, but it is of academic significance to quantify and compare lung emphysema in the context of clinical studies.

Keywords

computed tomography - prolonged air leak - emphysema - thoracic surgery - video-assisted thoracoscopic surgery

Publikationsverlauf

Eingereicht: 10. November 2024

Angenommen: 13. Januar 2025

Artikel online veröffentlicht:
14. Februar 2025

• References

• 1 Brunelli A, Chapman K, Pompili C. et al. Ninety-day hospital costs associated with prolonged air leak following lung resection. Interact Cardiovasc Thorac Surg 2020; 31 (04) 507-512
• 2 Ponholzer F, Ng C, Maier H, Lucciarini P, Öfner D, Augustin F. Risk factors, complications and costs of prolonged air leak after video-assisted thoracoscopic surgery for primary lung cancer. J Thorac Dis 2023; 15 (02) 866-877
• 3 Ji D, Sun R, Wu Z. Effects of uniportal thoracoscopic pulmonary segmentectomy and lobectomy on patients with early-stage non-small-cell lung cancer and risk factors of postoperative complications. Am J Transl Res 2023; 15 (06) 4369-4379
• 4 Gonzalez M, Karenovics W, Bédat B. et al. Performance of prolonged air leak scoring systems in patients undergoing video-assisted thoracoscopic surgery segmentectomy. Eur J Cardiothorac Surg 2022; 62 (03) ezac100
• 5 Kagimoto A, Mimura T, Miyamoto T, Nakashima C, Yamashita Y. Severity of emphysema as a prognosticator of resected early lung cancer: an analysis classified by Goddard score. Jpn J Clin Oncol 2020; 50 (09) 1043-1050
• 6 Kim YS, Kim EY, Ahn HK, Cho EK, Jeong YM, Kim JH. Prognostic significance of CT-emphysema score in patients with advanced squamous cell lung cancer. J Thorac Dis 2016; 8 (08) 1966-1973
• 7 Lee HY, Kim EY, Kim YS, Ahn HK, Kim YK. Prognostic significance of CT-determined emphysema in patients with small cell lung cancer. J Thorac Dis 2018; 10 (02) 874-881
• 8 Kagimoto A, Ishida M, Mimura T. Significance of the Goddard score in predicting complications related to air leak after lobectomy. Ann Thorac Surg 2024; 118 (01) 233-239
• 9 The jamovi project, jamovi. Accessed February 2, 2025; available at: https://www.jamovi.org
• 10 Team RC. R: A Language and Environment for Statistical Computing, Vienna, Austria. Accessed 2018 at: https://www.R-project.org/
• 11 Martinez FJ, Foster G, Curtis JL. et al. NETT Research Group. Predictors of mortality in patients with emphysema and severe airflow obstruction. Am J Respir Crit Care Med 2006; 173 (12) 1326-1334
• 12 Muriana P, Rossetti F, Viscardi S, Novellis P, Veronesi G. Prolonged air leak after robotic lung resection: a narrative review. J Thorac Dis 2023; 15 (02) 909-917
• 13 Clark JM, Cooke DT, Brown LM. Management of complications after lung resection: prolonged air leak and bronchopleural fistula. Thorac Surg Clin 2020; 30 (03) 347-358