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

Authors Yoo A, Ghosh SK, Danker W, Kassis E, Kalsekar I

Received 3 February 2017

Accepted for publication 3 May 2017

Published 29 June 2017 Volume 2017:9 Pages 373—383

DOI https://doi.org/10.2147/CEOR.S133830

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 2

Editor who approved publication: Professor Giorgio Lorenzo Colombo

Andrew Yoo,1 Sudip K Ghosh,2 Walter Danker,2 Edmund Kassis,3 Iftekhar Kalsekar1

1Medical Devices – Epidemiology, Johnson and Johnson, New Brunswick, 2Global Health Economics and Market Access, Ethicon Inc., Somerville, NJ, 3Medical Affairs, Ethicon Inc., Cincinnati, OH, USA

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, segmentectomy, wedge resection, outcomes

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