Material Use for Air Leakage Prevention Post-Lung Resection: Insights from Real-World Data in Japan

PURPOSE: Lung resection is a standard treatment for localized lung cancer, but prolonged air leakage is a common complication with health and economic burdens. Interventions such as staplers, sealants, and adjunctive materials are used, yet real-world data describing their utilization remain limited. METHODS: Using a hospital database with claims and discharge summaries from 393 hospitals in Japan, we identified patients undergoing lobectomy, segmentectomy, or partial resection for primary lung cancer between 2015 and 2020. We evaluated intraoperative use of staple-line buttresses, fibrin glue, polyglycolic acid (PGA) sheets, and other materials. Patient characteristics and comorbidities were compared across material-use categories, and the incidence of prolonged postoperative drainage (≥7 days) was assessed. RESULTS: Among 33094 lobectomy, 5443 segmentectomy, and 8242 partial resection patients, buttress use was uncommon (2.2%, 3.5%, and 6.4%). Patients receiving buttresses or PGA plus fibrin glue had higher prevalences of emphysema and interstitial pneumonia than those in the stapler-only group. Prolonged drainage remained frequent (6.9% in stapler-only vs. 24.8% in buttress among lobectomy patients) and was associated with nearly doubled postoperative in-hospital costs. CONCLUSIONS: Prolonged air leakage remains a major complication following lung resection, associated with clinical and economic burden. This study provided a nationwide overview of real-world utilization patterns of adjunctive materials.