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. 2017 Jun 29:9:373-383.
doi: 10.2147/CEOR.S133830. eCollection 2017.

Burden of air leak complications in thoracic surgery estimated using a national hospital billing database

Andrew Yoo  1 , Sudip K Ghosh  2 , Walter Danker  2 , Edmund Kassis  3 , Iftekhar Kalsekar  1
Affiliations

Burden of air leak complications in thoracic surgery estimated using a national hospital billing database

Andrew Yoo et al. Clinicoecon Outcomes Res. .

Abstract

Background: One of the most common outcomes of lung resections are parenchymal air leaks. These air leaks are most often self-limited and spontaneously resolve several days after surgery. Historically, only prolonged air leaks have been considered to have a significant effect on patient outcomes. This study aims to evaluate the impact of any air leak complications (aALCs) on resource utilization and mortality.

Methods: The Premier Perspective® database was used to identify all elective primary lobectomy, segmentectomy, and wedge resections performed from 2012 to 2014; aALC was defined as a composite of air leak and pneumothorax. Generalized estimating equation models were used to estimate the impact of aALCs on length of stay (LOS), operating room time (ORT), hospital costs, and mortality during index hospitalization.

Results: A total of 21,150 patients undergoing lung resection surgery were included in the analysis: lobectomy (n=10,946), segmentectomy (n=1,788), and wedge resection (n=8,416). The overall incidence of aALCs was 24.26% (95% CI [23.68, 24.83]). Identified risk factors included resection type, surgical approach, male gender, and presence of COPD. Patients with aALCs had a significantly higher economic burden (adjusted mean [standard error of mean, SE]: LOS=7.24 [SE=0.12] days; ORT=214.9 [SE=6.4] min; and hospital costs=$26,070 [SE=$1404]) compared to those without aALCs (adjusted mean [SE]: LOS=4.75 [SE=0.07] days; ORT=201.7 [SE=3.9] min; and hospital costs=$19,558 [SE=$399]). aALC was also associated with increased overall index hospitalization mortality (odds ratio=1.90, 95% CI [1.42, 2.55]).

Conclusion: This analysis showed that aALCs are not only frequent but also associated with significantly higher resource utilization and mortality.

Keywords: lobectomy; outcomes; segmentectomy; wedge resection.

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Figures

Figure 1
Figure 1
Patient-related factors associated with aALC. Notes: Values represent odds ratios, and error bars represent 95% CIs. *Charlson Comorbidity Index. Abbreviations: aALC, any air leak complication; CCI, Charlson Comorbidity Index.
Figure 2
Figure 2
Provider-related factors associated with aALC. Note: Values represent odds ratios, and error bars represent 95% CIs. Abbreviations: aALC, any air leak complication; VATS, video-assisted thoracoscopic surgery; RCC, ratio of cost to charge.
Figure 3
Figure 3
Association between air leak and hospital LOS (overall and by resection type). Abbreviation: LOS, length of stay.
Figure 4
Figure 4
Association between air leak and ORT (overall and by resection type). Abbreviation: ORT, operating room time.
Figure 5
Figure 5
Association between air leak and hospital costs (overall and by resection type).
Figure 6
Figure 6
Association between any air leak complications and mortality.
See this image and copyright information in PMC

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