Trends in Lung Surgery: General

Trends in Lung Surgery: GeneralThe mortality of patients undergoing lung resections was also examined. For this analysis, the characteristics of the patients who died were compared to the characteristics of the entire sample of those undergoing lung resections during the study period.
Changes in mortality between time periods were also assessed, but these analyses must be interpreted with caution, as the weighted number of patients having a fatal outcome in each period was below 9,000. Research suggests that weighted estimates between 5,000 and 9,000 are potentially unstable. The same caution in the interpretation of data related to individual complication codes should be exercised where indicated. The significance of the changes over time was assessed first using x2 tests and then using Z-scores for categorical variables, and with general linear models for continuous variables.
Table 2 describes the characteristics of the overall sample population (last column) and changes in the prevalence of studied variables over time. The majority of patients in the total sample were male, were white, had been discharged to home after their surgery, and were insured by Medicare. The average age was 62.4 years (range, 1 to 91 years), and the average length of care was 10.8 days (range, 1 to 358 days). The majority of cases occurred in hospitals with a bed size of 200 to 499. The number of lobectomies surpassed the number of pneumonectomies and segmentectomies combined (Fig 1). Between 1988 and 2002, the average age of patients with lung resections increased from 61.1 years (range, 1 to 89 years) to 63.2 years (range, 1 to 91 years), respectively (Table 2). More recently, a higher proportion of patients was female (49.6%) compared to the earliest period (40.1%). While the proportion of white patients decreased over time, the number of patients for whom no race was stated increased, limiting any interpretation of the impact of race on outcomes.

Table 2—Characteristics of Patients Undergoing Lung Resection From 1988 to 2002

Characteristics 1988-1992 1993-1997 1998-2002 1988-2002
Subjects, No. (%) 166,126 (32.4) 184,212 (35.9) 162,420 (31.7) 512,758 (100%)
Age, yr (range)* 61.1 (1-89) 62.7 (1-89) 63.2 (1-91) 62.4 (1-91)
Genderf
Male|§ 59.9 50.1 50.4 53.3
Female|§ 40.1 49.9 49.6 46.7
Racef
Whitej 80.5 76 67.3 74.7
BlackJ 6.7 5.5 5.9 6
Other! 2.5 2.1 3.4 2.7
Not stated! 10.4 16.5 23.1 16.6
Hospital discharge statusf
Routine discharge to home! 86.1 84.6 79.5 83.4
Left against medical advice! 1 0 0.1 0 0.1
Discharge to short-term facility! 0.8 1.8 3.1 1.9
Discharge to long-term facility! 2.7 3.7 5.2 3.8
Alive disposition not stated! 4.2 5.1 6.8 5.4
Dead! 5 4.1 5.4 4.8
Not stated or reported! 1.3 0.7 0 0.7
Hospital bed sizef
6-99! 4.2 6.9 4.6 5.3
100-199!|| 19.3 20.0 19.1 19.5
200-299! 23.8 21.8 27.0 24.1
300-499! 36.0 31.0 33.9 33.6
> 500! 16.7 20.3 15.4 17.6
Primary source of paymentf
Medicare! 43.8 50 49 47.7
Medicaid!^ 4.7 5 6.7 5.5
Private! 37.9 35.1 39.8 37.5
Other! 9.1 8.7 3.8 7.3
Not stated! 4.4 1.2 0.7 2.1
Length of care, d (range)* 12.9 (1-358) 10(1-93) 9.1 (1-175) 10.8 (1-358)

Figure-1

Figure 1. Distribution of types of lung resection from 1988 to 2002.

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