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Increasing Numbers and Reported Adverse Events in Patients with Lung Cancer Undergoing Inpatient Lung Biopsies: A Population-Based Analysis

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Abstract

Introduction

The use of molecular biomarkers to guide lung cancer management has led to increasing frequency and amounts of tissue required for repeat lung biopsies. While patient safety and reporting of adverse events has been increasingly emphasized in recent decades, the safety of lung biopsies in patients with lung cancer has only been studied in small cohorts. We therefore analyzed adverse events in patients with lung cancer undergoing lung biopsies in the National Hospital Discharge Survey (NHDS) database.

Methods

Data were abstracted using ICD-9 lung cancer diagnosis (162.X) and lung biopsy procedure codes (33.20, 33.24, 33.25, 33.26, 33.27, 33.28) from 2001 to 2010. Agency for Healthcare Research and Quality (AHRQ) Patient-Safety Indicators (PSI) were used to identify hospital-acquired adverse events. Weighted analyses were performed using SAS version 9.4.

Results

A total of 540,747 patients were included for analysis. The number of biopsies increased over time, from 51,221 in 2001, to 63,239 in 2010 (P < 0.001). Overall, 159,683 (30%) patients suffered ≥ 1-PSI event during their hospitalization. Incidence of PSI varied by biopsy type: bronchoscopic (26%), percutaneous (34%), surgical (39%). The proportion of patients with ≥ 1 PSI event increased from 24% in 2001 to 38% in 2010 (P < 0.001). Patients with ≥ 1 PSI had longer length of stay (mean, 11.6 vs 8.1 days; P < 0.001) and higher in-hospital mortality (adjusted odds ratio, 5.9, 95% CI 3.9–8.9; P < 0.001).

Conclusions

The frequency of lung biopsies performed and rate of documented adverse events in hospitalized lung cancer patients have increased. These findings have policy, funding, research, and practice implications.

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Acknowledgements

The authors thank Helen Mayo, MLS from the UT Southwestern Medical Library for assistance with literature searches. The authors thank Ms. Dru Gray for assistance with manuscript preparation.

Funding

Funded in part by a National Cancer Institute Midcareer Investigator Award in Patient-Oriented Research (K24 CA201543-01; to DEG). This work is not under consideration for publication elsewhere. If accepted, this work will not be published elsewhere without written consent of the copyright-holder.

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Author notes

  1. Arjun Gupta

    Present address: Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, USA

  2. Mitchell S. von Itzstein and Arjun Gupta contributed equally to this study.

Authors and Affiliations

  1. Department of Internal Medicine, UT Southwestern Medical Center, Dallas, USA

    Mitchell S. von Itzstein, Arjun Gupta & David E. Gerber

  2. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Kristin C. Mara

  3. Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA

    Sahil Khanna

  4. Department of Population & Data Sciences, UT Southwestern Medical Center, Dallas, USA

    David E. Gerber

  5. Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, 75390-9093, USA

    David E. Gerber

  6. Division of Hematology-Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8852, Dallas, TX, 75390-8852, USA

    David E. Gerber

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  1. Mitchell S. von Itzstein
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Correspondence to David E. Gerber.

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von Itzstein, M.S., Gupta, A., Mara, K.C. et al. Increasing Numbers and Reported Adverse Events in Patients with Lung Cancer Undergoing Inpatient Lung Biopsies: A Population-Based Analysis. Lung 197, 593–599 (2019). https://doi.org/10.1007/s00408-019-00255-y

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  • DOI: https://doi.org/10.1007/s00408-019-00255-y

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