Trends in Lung Surgery: Procedure-Related Complications

Trends in Lung Surgery: Procedure-Related ComplicationsStudies have suggested that there are better outcomes if lung surgery is performed in high-volume hospitals. While a trend to increasing mortality over time in hospitals with < 99 beds was seen compared to a decrease in mortality in hospitals with a size of 100 to 199 beds, these data are to be interpreted with caution as they may potentially be unstable due to the small weighted sample size, as discussed previously. In contrast, the ratio of fatalities to total procedures performed seemed to be more favorable in hospitals with < 99 beds when compared to hospitals with 200 to 299 beds (3.3%/ 5.3% vs 31.5%/24.1%, respectively). While the complexity of cases at larger hospitals may account for this finding, our data do not allow a definitive interpretation.
In addition, male gender and increasing age have been implicated previously as risk factors for mortality after lung surgery. However, the lack of important information, such as American Society of Anesthesiologists score or disease stage, in the NHDS prohibits a meaningful regression analysis and the determination of whether these factors are independently associated with mortality.
Procedure-related complications were recorded in almost one quarter of patients. However, these numbers may be underestimating the true incidence of adverse events occurring after lung resection, due to the limitations of the NHDS database. For instance, patients who left the hospital after their procedure and then were readmitted for treatment of their complication are not captured. In addition, the entry of an event as related to the procedure may vary significantly by physician assessment and may be subject to individual coding practices.
We found a decrease in the frequency of procedure-related complications over time from 29.1% to 21.8%. This decrease was paralleled by a decrease in the prevalence of pulmonary complications. The reasons for these findings cannot be determined by our data. However, improvements in medical care and patient selection may be partially responsible for our findings.
This study provides valuable, nationally representative information on the evolution of lung resection surgery. Increasing age, the rise in the proportion of Medicare recipients undergoing lung resections, as well as increasing numbers of patients being discharged from the hospital to other health-care facilities have a significant financial impact on the healthcare system. The rise in noncancer indications for lung surgery, like HIV-related diagnoses, is of importance to physicians, as they may need to expand their practice spectrum. The closure of the gender gap and the decrease in the length of care and in the frequency of complications are additional important findings of our study. Future research is needed to assess trends when controlling for potentially confounding factors. Our data may help in the construction of health-care policies to address the changing needs of and financial burdens on the health-care system.

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