PURPOSE: Pneumonectomy remains a procedure with an associated high morbidity and mortality. Increasing use of sleeve resection and avoidance of pneumonectomy in patients undergoing induction therapy may have decreased the use of pneumonectomy. This study aims to investigate variations in age, gender, hospital volume and associated mortality for patients undergoing pneumonectomy over a decade long period.
METHODS: Inpatient discharge claim forms were queried for all pneumonectomies, lobectomies, and segmentectomies performed for cancer in the mid-atlantic region (PA, NJ, and NY) between 2000-2008. Outcomes were analyzed using T-tests.
RESULTS: 56,636 major lung resections were performed for cancer from 2000-2008. The total volume of major lung resections performed yearly has not increased from 2000 to 2008 (p = NS). Over the study period, 4254/56,636 (7.5%) of major lung resections were pneumonectomies. Of the 4254 patients undergoing pneumonectomy, 64% were male, 43% were aged >65. Relative to lobectomies, pneumonectomy cases have decreased over time (p=0.048). The number of pneumonectomies performed at high volume centers (> 10 cases per year) has increased over the study period (p< 0.001). Lower volume centers still perform 50% or more of the pneumonectomies. Females and those aged >65 experienced higher mortality (P=0.002 and P< 0.001). Overall morbidity did not change during the study period (25-40%; p =NS). Hospital mortality after pneumonectomy has decreased over the study period (P=0.049).
CONCLUSION: In the mid-Atlantic US, the pneumonectomy/lobectomy ratio has decreased over the past decade. Hospital mortality for pneumonectomy has also decreased while an increasing number of hospitals perform more than 10 pneumonectomies per year.
CLINICAL IMPLICATIONS: Over the past decade, pneumonectomies were performed less often for cancer in the mid-atlantic US, reflecting a possible increase in the use of lung conserving techniques(e.g sleeve resection). Avoidance of pneumonectomy in patients undergoing induction therapy, referral to specialized centers, and better perioperative care may account for lower observed hospital mortality.
DISCLOSURE: Walter Scott, No Financial Disclosure Information; No Product/Research Disclosure Information