We hypothesized that patient characteristics and procedure choice for lung resections is evolving over time. The purpose of this study was to characterize temporal changes in lung resection surgery (pneumonectomies (PE), lobectomies (LE) and segmentectomies (SE)) from 1988 to 2002.
Raw data collected in the National Hospital Discharge Survey (NHDS) from 1988 to 2002 were accessed, read into a statistical software package, and concatenated. Lung resection procedures (PE, LE, SE) were identified using ICD-9 procedure codes (32.5, 32.4 and 32.3, respectively). Five year periods of interest (POI) were created for temporal analysis (1988-1992= POI 1, 1993-1997=POI 2, and 1998-2002= POI 3) and changes in the prevalence of procedures were examined by POI. Changes in mortality, length of care (LOC), disposition of discharge to home, age, and gender were evaluated for each procedure across POI. Significance of changes over time within procedure was assessed using Z scores and general linear models for categorical and continuous variables, respectively.
There were 512,758 lung resection procedures performed during the study period; of those 32.4 % were performed in POI 1, 35.9% in POI 2, and 31.7% in POI 3 (Table 1). The proportion of LE increased over time while that of SE and PE decreased. The average patient age increased for SE and PE procedures between POI 1 and POI 3, while the LOC decreased for all procedures over time. Except for SE, the proportion of females undergoing lung surgery increased from POI 1 to 3. A decline in the proportion of patients with a disposition of discharge to home was found for PE and LE. There were no consistent trends in mortality.
We were able to identify temporal trends in lung resection procedures over a 15 year period. Further analysis is needed to evaluate our findings in more detail.
Our results are based on nationally representative data. By identifying trends associated with lung resection surgery, these results may aid in hospital policy planning, such as resource allocation/management.
Stavros Memtsoudis, None.