The association between patient preoperative disposition and outcomes after diagnostic lung biopsy

Adam R Dyas; Christina M Stuart; Yizhou Fei; Jake L Cotton; Kathryn L Colborn; Michael J Weyant; Simran K Randhawa; Elizabeth A David; John D Mitchell; Christopher D Scott; Robert A Meguid

doi:10.21037/jtd-23-1724

The association between patient preoperative disposition and outcomes after diagnostic lung biopsy

J Thorac Dis. 2024 Feb 29;16(2):1141-1150. doi: 10.21037/jtd-23-1724. Epub 2024 Feb 22.

Authors

Adam R Dyas^{1

2}, Christina M Stuart^{1

2}, Yizhou Fei^{2

3}, Jake L Cotton^{1

2}, Kathryn L Colborn^{2

3

4}, Michael J Weyant⁵, Simran K Randhawa¹, Elizabeth A David¹, John D Mitchell¹, Christopher D Scott⁶, Robert A Meguid^{1

2

3}

Affiliations

¹ Department of Surgery, University of Colorado, Aurora, CO, USA.
² Surgical Outcomes and Applied Research, University of Colorado, Aurora, CO, USA.
³ Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA.
⁴ Department of Medicine, University of Colorado, Aurora, CO, USA.
⁵ Division of Cardiothoracic Surgery, Inova Health System, Falls Church, VA, USA.
⁶ Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, VA, USA.

Abstract

Background: Surgical diagnostic lung biopsy (DLB) is performed to guide the management of pulmonary disease with unclear etiology. However, the utilization of surgical DLB in critically ill patients remains unclear. The purpose of this study was to determine if patient preoperative disposition impacts complication rates after DLB.

Methods: This was retrospective cohort study using electronic health record (EHR) data at one academic institution [2013-2021]. Patients who underwent DLB were identified using current procedural terminology (CPT) codes and cohorted based on preoperative disposition. The primary outcome was 30-day mortality; secondary outcomes were overall morbidity, individual complications, and changes to medical therapy. Complication rates were compared using chi-squared tests, Fisher's exact tests, or analysis of variance (ANOVA). Multivariable logistic regression was performed to generate risk-adjusted odds ratios (ORs) for each complication.

Results: Of 285 patients, 238 (83.5%) presented from home, 26 (9.1%) from inpatient floor units, and 21 (7.4%) from intensive care units (ICUs). Patients requiring ICU had the highest 30-day rates of mortality, overall morbidity, and all individual complications (all P<0.05). After risk adjustment, non-ICU inpatients had higher odds of postoperative ventilator use, prolonged ventilation, and ICU need than outpatients (all P<0.05). Preoperative ICU disposition was associated with increased OR of 30-day mortality [OR, 70.92; 95% confidence interval (CI): 5.55-906.32] and overall morbidity (OR, 7.27; 95% CI: 1.93-27.42) compared to patients with other preoperative dispositions. There were no differences in changes to medical therapy between the cohorts.

Conclusions: Patients requiring ICU before DLB had significantly higher risk-adjusted rates of mortality and postoperative complications than outpatients and other inpatients. A clear benefit from tissue diagnosis should be defined prior to performing DLB on critically ill patients.

Keywords: Diagnostic lung biopsy (DLB); critical care; intensive care; postoperative outcomes; risk assessment.