OBJECTIVES: Prolonged air leaks (PAL) lasting >5 days occur in up to 50% of all patients undergoing lung volume reduction surgery (LVRS); resulting in increased length of stay (LOS), patient morbidities, and health care costs.  We sought to map care path options for the management of PAL following LVRS among emphysematous patients, and to report estimates of associated costs. METHODS: Peer-reviewed English language articles from January 2000 – September 2012 were searched using pre-identified terms. A typical care path for a male smoker with emphysema was mapped from diagnosis to removal of chest tube after LVRS. Parameters extracted from the identified articles were country/region, year, type of study, type of procedure [open vs. video-assisted thoracoscopic surgery (VATS)], number of patients, cost, LOS and complication rates. RESULTS: The care path captured treatment events from diagnosis of nodules to post-surgical follow up care. PAL treatment options included the Heimlich valve, autologous blood patch or both prior to discharge. Eleven studies reporting cost data for 4,945 VATS procedures and 18,033 open procedures were identified. LOS [3.0 – 17.3 days (VATS) vs. 5.0 to 23.8 days (open)], hospital costs [US unadjusted: $10,084 to $23,826 (VATS) vs. $12,119 - $25,125 (open)] and complication rates were lower for VATS vs. open procedures. Similar cost differences were reported in Korea, Japan and China. Post-discharge care and cost of patients with PAL were driven by the utilization of home health care, increased pain management costs, more frequent doctor visits and delayed return to work. CONCLUSIONS: There is wide variability in the care path options associated with management of PAL and associated complications during LVRS in emphysema patients. VATS appears to have a positive health care utilization and cost advantage vs. open procedures globally. Further analyses are needed to quantify the true cost of care associated with managing PAL in LVRS patients.