Trends in Lung Surgery: Discussion

This study analyzed nationally representative data of lung resections in the United States between 1988 and 2002. We identified a number of changes over time related to patient age, gender, race, disposition status, expected source of payment, hospital size, length of hospital stay, and mortality. Temporally, patients undergoing lung surgery were older, more likely to be female, had a shorter length of stay, were less likely to be discharged to their home residence, and had similar in-hospital mortality rates over the time periods of the study. The frequencies of procedure-related complications decreased over time. While the specific reasons for these changes cannot be explained by our analysis, these trends are important to inform public policy and health-care administration decisions, and are discussed below in the context of the current literature. We identified a change in the overall number of lung resections performed between time periods, with an increase in the mid-1990s (ie, from 1993 to 1997) and a subsequent decrease in the most recent time period (ie, from 1998 to 2002) back to the level seen in the first period (1988 to 1992).

Lobectomy was the most commonly performed procedure, accounting for 67.0% of all resections. The proportion of lobectomies compared to segmentectomies and pneumonectomies gradually increased over time. This finding may be partially explained by advances in the screening for lung cancer, which is the most common indication for lung resection in our study. Screening may allow for earlier diagnosis when the spread of disease is limited, potentially explaining the decrease in the rate of pneumonectomies performed in more recent years. Furthermore, a reduced risk of local recurrence with lobectomy rather than sublobar resections for early-stage (ie, stage I [T1N0M0]) small cell lung cancer could account for a decrease in the rate of segmentectomies. Changes in the rates of lobectomies were also found in a recent Canadian study that evaluated trends of lung resections for lung cancer. Over time, the most common indications for lung resection surgery remained malignancies of the lungs and bronchi. Interestingly, HIV-related indications have made the top 10 diagnosis list during the most recent time period studied. This finding may be explained by the increase in the number of patients surviving this disease long enough for pulmonary manifestations (ie, malignant or infectious diseases needing either therapeutic or diagnostic intervention) to develop.

This entry was posted in Lung injury and tagged epidemiology, lung, surgery.