AI Article Synopsis
- Surgical diagnostic lung biopsy (DLB) is important for managing pulmonary diseases, but its safety in critically ill patients is not well established. This study aimed to see if a patient's pre-surgery condition affects complication rates post-DLB.
- Data from 285 patients showed those coming from the ICU had the highest rates of 30-day mortality and complications, with ICU patients having a significantly greater risk of negative outcomes compared to outpatients.
- The findings suggest that critically ill patients undergoing DLB are at greater risk for serious complications and death within 30 days, indicating the need for careful consideration before this procedure in such vulnerable populations.
Article 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.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10944776 | PMC |
| http://dx.doi.org/10.21037/jtd-23-1724 | DOI Listing |
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