PURPOSE: Operative resections for pulmonary nodules suspicious for lung cancer that result in benign diagnoses are perceived to cause unnecessary cost, societal burden, morbidity, and mortality risk to the patient. Previous studies of patients who have undergone pulmonary nodule resection have not evaluated whether the benign diagnoses affect subsequent patient management. This study examines whether benefits to patient care result from “negative” thoracic operations.
METHODS: 279 thoracic surgery cases were performed for known or possible malignancy at an academic medical center between January 1, 2005 and April 1, 2009. For patients with benign pathology, we collected preoperative patient and nodule characteristics, diagnosis, post-operative treatment changes, peri-operative morbidity and mortality, and hospital charges.
RESULTS: 65 patients (23%) had benign pathology. Mean size of benign nodules was 20.8mm and these were PET avid in 62%. Pathology revealed granulomatous disease in 57%, benign tumors in 15%, fibrosis in 12%, and autoimmune and vascular diseases in 9% of benign cases. Surgical intervention provided a new diagnosis in 69% of benign cases and led to a treatment change in 69%. The new diagnosis required a medication change in 37% and new consultation in 31%. Management of the patient’ s underlying disease awaited operative results in 35% of benign cases. There were no intraoperative, in-hospital, or 30-day mortalities in the benign group. Post-operative in-hospital events occurred in 7 benign cases (11%). The mean hospital cost to charge ratio was $13,610 (Median = $10,932) or $3,678 per day.
CONCLUSION: Patients who receive a benign diagnosis after surgical evaluation of an indeterminate pulmonary nodule often benefit from this intervention with minimal surgical morbidity and mortality. However, obtaining this new information from surgical resection has considerable costs and further studies are needed to determine the most cost-effective strategies for management of patients with pulmonary nodules.
CLINICAL IMPLICATIONS: Patients with benign disease after surgical resection of an indeterminate nodule frequently require a change in their treatment plan.
DISCLOSURE: Eric Grogan, No Financial Disclosure Information; No Product/Research Disclosure Information