Trends in Lung Surgery: Patients

Over time, fewer patients were discharged to their home residence and an increasing proportion was discharged to short-term and long-term care facilities. An increase in the proportion of Medicare and Medicaid patients was also found, most recently representing > 55% of all patients. The proportion of procedures performed in the smallest and the largest hospitals (< 99 and > 500 beds, respectively) increased compared to that performed in midsize hospitals between the first and the second time period. However, this trend was reversed in the most recent study period.
The average length of care dropped by nearly 30% from an average of 12.9 days in period 1 (1988 to 1992) to 9.1 days in period 3 (1998 to 2002). Additionally, the proportion of patients who had undergone lobectomies increased steadily over time (period 1, 60.1% of total number of procedures; period 2, 67.4% of total number of procedures; period 3, 74.4% of total number of procedures), while the proportions of pneumonectomies (period I,    16.4% of total number of procedures; period 2, II.1%    of total number of procedures; period 3, 10.4% of total number of procedures) and segmen-tectomies (period 1, 23.5% of total number of procedures; period 2, 21.5% of total number of procedures; period 3, 15.7% of total number of procedures) decreased.
Table 3 lists the 10 most common primary ICD-9-CM codes for diagnoses associated with lung resection procedures from 1988 to 2002. Primary malignancies of the lung remained the most common indication for surgery over time. More recently, indications such as lung abscesses and HIV-related indications have made the top 10 list of indications.
Complications related to the procedure developed in a total of 22.8% of patients during the entire study period. Of those patients, 84.2% experienced one complication, 15.5% experienced two complications, and 1.3% experienced three or more complications. The frequencies of complications were 29.1% (1988 to 1992), 29.0% (1993 to 1997), and 21.8% (1998 to 2002). Table 4 provides data related to individual procedure-related complications over time. The most commonly recorded complications were pulmonary, followed by cardiac complications.

Table 3—The 10 Most Common ICD-9-CM Diagnoses Associated With Lung Resection Procedures From 1988 to 2002

1988-1992 1993-1997 1998-2002 1988-2002
Diagnosis % Diagnosis % Diagnosis % Diagnosis %
Malignancy upper lobe, bronchus or lung 42.6 Malignancy upper lobe, bronchus or lung 44.2 Malignancy upper lobe, bronchus or lung 43.4 Malignancy upper lobe, bronchus or lung 43.4
Malignancy lower lobe, bronchus or lung 21.3 Malignancy lower lobe, bronchus or lung 19.2 Malignancy lower lobe, bronchus or lung 24.6 Malignancy lower lobe, bronchus or lung 21.6
Malignancy bronchus and lung, unspecified 6.3 Malignancy other parts of bronchus or lung 4 Malignancy middle lobe, bronchus or lung 3.6 Malignancy bronchus and lung, unspecified 4
Secondary malignant neoplasm lung, bronchus 3.7 Malignancy middle lobe, bronchus or lung 3.7 Secondary malignant neoplasm lung, bronchus 3.4 Malignancy other parts of bronchus or lung 3.4
Postinflammatory pulmonary fibrosis 3.4 Malignancy bronchus and lung, unspecified 3.4 Malignancy other parts of bronchus or lung 3.2 Secondary malignant neoplasm lung, bronchus 3.2
Malignancy other parts of bronchus or lung 2.9 Secondary malignant neoplasm lung, bronchus 2.7 Malignancy bronchus and lung, unspecified 2.5 Malignancy middle lobe, bronchus or lung 3.1
Malignancy middle lobe, bronchus or lung 2 Postinflammatory pulmonary fibrosis 2 Swelling, mass, or lump in chest 1.5 Postinflammatory pulmonary fibrosis 2.3
Bronchiectasis 1.2 Malignancy main bronchus (ie, carina and hilus) 1.9 Postinflammatory pulmonary fibrosis 1.5 Malignancy main bronchus (ie, carina and hilus) 1.3
Other diseases of lung, not elsewhere classified 1.2 Other diseases of lung, not elsewhere classified 1.9 Abscess of lung 1.4 Other diseases of lung, not elsewhere classified 1.2
Other spontaneous pneumothorax 1.1 Bronchiectasis 1.5 HIV disease 0.9 Bronchiectasis 1

Table 4—Characteristics of Deaths After Lung Resection From 1988 to 2002 by Time Period and in Comparison to Nondeaths

Characteristics 1988-1992 1993-1997 1998-2002 Total Deaths Total Study Population
Deaths, No. (%) 8,230 (5) 7,469 (4.1) 8,717 (5.4) 24,416 (4.80) 512,758 (100)
Age, yr (range) 66.2 (34-84) 68.6 (16-87) 66.7 (18-83) 67.1 (16-87) 62.4 (1-91)
Genderf
Male!§ 74.1 83.8 77.7 78.4 53.3
Female 25.9 16.6 22.3 21.6 46.7
Racef
White 84.2 74.3 71.9 76.8 74.7
Black 6.6 9.9 6.5 7.6 63
Other 1 0.5 6.6 2.8 2.7
Not stated 8.2 15.3 15.1 12.8 16.6
Hospital bed size
6-99 0.7 0.0 8.6 3.3 5.3
100-199 27.5 19.1 13.2 19.8 19.5
200-299 36.4 23.2 33.9 31.5 24.1
300-499 27.7 39.7 31.8 32.8 33.6
> 500 7.8 18.0 12.6 16.3 17.6
Primary source of payment
Medicare 58.5 69.2 63 63.4 47.7
Medicaid 0.5 6.5 7.9 5 5.5
Private 22.1 17.3 27.9 22.7 37.5
Other 16.9 7 1.3 8.3 7.3
Not stated 2 0 0 0.7 2.1
Length of care, d (range) 16.6(1-92) 14 (1-60) 15 (1-57) 15.2 (1-92) 10.8 (1-358)
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