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Hutchinson, John P. and Fogarty, Andrew W. and McKeever, Tricia M. and Hubbard, Richard B. (2016) In-hospital mortality following surgical lung biopsy for interstitial lung disease in the USA: 2000-2011. American Journal of Respiratory and Critical Care Medicine, 193 (10). pp. 1161-1167. ISSN 1535-4970

Abstract

Rationale: Surgical lung biopsy can help to determine a specific diagnosis in interstitial lung disease, but has associated risks. Most currently available mortality data are derived from case series and may not be generalizable to broader populations.

Objectives: We aimed to assess in-hospital mortality following surgical lung biopsy for interstitial lung disease in a national secondary care dataset from the United States.

Methods: Data were obtained from the 2000-2011 Nationwide Inpatient Sample. Cases were identified using International Classification of Diseases (ICD-9-CM) codes for interstitial lung disease and surgical lung biopsies. Lung resections and cases of lung cancer were excluded. Weighted data were used to estimate numbers of biopsies nationwide and in-hospital mortality, and multivariable logistic regression was used to adjust for sex, age, geographic region, co-morbidity, type of operation and provisional diagnosis.

Measurements and Main Results: We estimated there to be around 12,000 surgical lung biopsies performed annually for interstitial lung disease in the United States, two-thirds of which were performed electively. In-hospital mortality was 1.7% for elective procedures, but significantly higher for non-elective procedures (16.0%). Male sex, increasing age, increasing co-morbidity, open surgery and a provisional diagnosis of idiopathic pulmonary fibrosis or connective tissue disease related interstitial lung disease were risk factors for increased mortality.

Conclusions: In-hospital mortality following elective surgical lung biopsy for interstitial lung disease is just under 2%, but significantly higher for non-elective procedures. Identified risk factors for death should be taken into account when counselling patients on whether to pursue a histological diagnosis.

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