Trends in Lung Surgery: Length of Care and Hospital Discharge Status

The average length of care after lung resection for all indications decreased dramatically over 15 years. This decrease may be explained by factors such as the identification of reasons for prolonged stays and ways to address them, the advent of new surgical techniques such as VATS, and the maturation of patient care pathways.
We found that the number of patients being discharged from the hospital to short-term and longterm facilities rather than to home increased. Similarly, decreased lengths of hospital stays after cardiac surgery and increased rates of discharge to nursing homes and other skilled nursing facilities have been described in response to prospective payment and managed care in the 1990s.
Lung resection surgery is associated with one of the highest perioperative mortality rates of any surgical procedure and has been reported to reach almost 70% for pneumonectomies performed after chest trau-ma. A number of factors have been identified to influence postoperative mortality including increasing age, extent of lung resection (pneumonectomy vs lobectomy), specialty of the surgeon performing the procedure, American Society of Anesthesiologists score of at least 3, increased operating time, and prolonged mechanical ventilation. Mortality rates changed little over time, yielding an average of 4.8%. The in-hospital mortality rates after lung resection for lung cancer that have been reported in cross-sectional studies varies. Rates as low as 0.8% have been published and represent a marked improvement from 1971 when the inhospital mortality rate was 13.5%. However, these selected reports may suffer from publication bias, as few centers report high mortality rates. Additionally, the relatively low mortality rates found in these studies may reflect the fact that data were collected at highly specialized institutions and only from patients undergoing resections for lung cancer. In contrast, our study used nationwide data from hospitals of all sizes and included patients undergoing resections for all indications, and hence is more generalizable and representative.
We compared the characteristics of the patients undergoing lung resections who died during their hospitalization to those who survived. Interestingly, those who died after surgery were on average 5 years older (67.1% vs 62.4%, respectively), were more likely to be men (78.4% vs 53.3%, respectively) and Medicare recipients (63.4% vs 47.7%, respectively), and had a longer length of care (15.2 vs 10.8 days, respectively) when compared to the overall sample.

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