Key result
Reported adverse events during lung cancer resection increase, while associated in-hospital mortality drops ~88%.
Why the study?
Surgical advances have decreased complications while heightened attention to care quality has increased adverse event reporting, creating divergent effects on the reported safety of lung cancer resection.
Does the incidence and associated mortality of hospital-acquired adverse events change over time in patients undergoing lung cancer resection?
Observational (n=302,444)
Yes
Does the incidence and associated mortality of hospital-acquired adverse events change over time in patients undergoing lung cancer resection?
Despite an increase in reported hospital-acquired adverse events after lung cancer surgery, associated in-hospital mortality significantly decreased over a 10-year period, suggesting changes in coding practices or improved complication management.
Answers are grounded in this paper and cite their sources.
Rising adverse event rates after lung cancer resection warrant caution in trend interpretation; hypothesis-generating for coding changes versus improved management.
INTRODUCTION: Advances in surgical techniques have improved clinical outcomes and decreased complications. At the same time, heightened attention to care quality has resulted in increased identification of hospital-acquired adverse events. We evaluated these divergent effects on the reported safety of lung cancer resection. METHODS AND MATERIALS: We analyzed hospital-acquired adverse events in patients undergoing lung cancer resection using the National Hospital Discharge Survey (NHDS) database from 2001-2010. Demographics, diagnoses, and procedures data were abstracted using ICD-9 codes. We used the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSI) to identify hospital-acquired adverse events. Weighted analyses were performed using t-tests and chi-square. RESULTS: A total of 302,444 hospitalizations for lung cancer resection and were included in the analysis. Incidence of PSI increased over time (28% in 2001-2002 vs 34% in 2009-2010; P<0.001). Those with one or more PSI had increased in-hospital mortality (aOR = 11.1; 95% CI, 4.7-26.1; P<0.001) and prolonged hospitalization (12.5 vs 7.8 days; P<0.001). However, among those with PSI, in-hospital mortality decreased over time, from 17% in 2001-2002 to 2% in 2009-2010. CONCLUSIONS: In a recent ten-year period, documented rates of adverse events associated with lung cancer resection increased. Despite this increase in safety events, we observed that mortality decreased. Because such metrics may be incorporated into hospital rankings and reimbursement considerations, adverse event coding consistency and content merit further evaluation.
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Itzstein et al. (2020) conducted an observational in Lung cancer (n=302,444). Hospital-acquired adverse events (Patient Safety Indicators) vs. No adverse events was evaluated on In-hospital mortality associated with one or more Patient Safety Indicators (aOR 11.1, 95% CI 4.7-26.1, p=<0.001). Hospital-acquired adverse events during lung cancer resection increased in reported incidence from 28% to 34%, while in-hospital mortality among affected patients decreased from 17% to 2%.
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