Clinical efficacy of surgical sealants after pulmonary resection: an individual patient data meta-analysis of randomized controlled trials.

BACKGROUND

Alveolar air leaks following pulmonary resection present a significant challenge in thoracic surgery, resulting in complications and increased healthcare costs. Surgical sealants are employed to reduce air leak duration, but evidence supporting their routine use remains limited. Our individual patient data meta-analysis of randomised controlled trials aimed to assess the impact of sealant use on the duration of hospital length of stay, air leak, and chest drainage following lung resection.

MATERIALS AND

METHODS

Our systematic literature search identified 22 randomized controlled trials, from which individual patient data were obtained from 7 trials involving 552 patients. The primary outcome was hospital length of stay, with air leak duration and chest drain duration as secondary outcomes. A one-stage individual patient data meta-analysis approach was used, applying Kaplan-Meier survival analysis, log-rank tests, and Cox proportional hazards models. Exploratory sub-group analyses were conducted to assess potential effect modification by extent of resection and presence of COPD on hospital length of stay.

RESULTS

Sealant use significantly reduced hospital stay duration (HR = 0.82;0.69-0.97; p = 0.02), air leak duration (HR = 0.70;0.56-0.87; p = 0.002) and chest drain duration (HR = 0.78;0.63-0.97; p = 0.02). In the subgroup analyses based on the extent of resection, sealants demonstrated benefit in the lobectomy (HR = 0.77;0.63-0.94; p = 0.01) and segmentectomy (HR = 0.54;0.36- 0.82; p = 0.003) groups. In the COPD patient subgroup, sealants did not lead to a significant reduction in all primary and secondary outcomes.

CONCLUSION

The use of surgical sealants after failed control of air leak following pulmonary resection results in a one-day reduction in hospital length of stay as compared to standard closure techniques.