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

Figures & data

Table 1 Baseline patient characteristics of the study cohort based on resection types

Patient characteristics	Wedge (n=8,416), %		Segmentectomy (n=1,788), %		Lobectomy (n=10,946), %
	Thoracotomy (n=1,784)	VATS (n=6,632)	Thoracotomy (n=672)	VATS (n=1,116)	Thoracotomy (n=5,870)	VATS (n=5,076)
Primary diagnosis
Cancer	67.8	50.0	82.9	81.6	94.5%	94.5%
Pulmonary fibrosis	10.5	19.3	3.1	5.1	0.7	0.9
Other	21.7	30.7	14.0	13.3	4.8	4.5%
Gender
Female	51.2	53.9	49.1	53.8	50.3	55.4
Age (years)
18–44	6.0	9.4	5.2	3.7	2.4	2.1
45–54	12.3	13.8	9.1	9.2	9.5	9.6
55–64	25.4	24.7	27.5	21.7	25.9	23.7
65–74	34.5	32.3	34.8	37.4	39.6	39.8
75+	21.9	19.8	23.4	28.0	22.7	24.8
Race
White	78.2	73.6	76.3	75.3	78.3	75.7
Black	7.1	7.0	8.5	6.7	7.2	7.6
Other	14.7	19.4	15.2	18.0	14.5	16.6
Marital status
Single	36.0	34.1	37.4	35.1	36.6	36.1
Married	52.1	50.3	48.5	50.1	53.2	47.6
Other	11.9	15.6	14.1	14.8	10.2	16.3
Payer
Commercial	32.3	38.4	31.7	31.0	29.1	30.3
Medicaid	7.0	6.6	6.1	4.4	5.8	5.6
Medicare	58.1	53.3	60.6	63.3	63.1	62.5
Other	2.6	1.7	1.6	1.3	2.0	1.7
Year
2012	38.3	34.0	39.7	35.7	35.6	32.0
2013	31.4	31.8	29.2	31.4	34.6	32.6
2014	30.2	34.2	31.1	33.0	29.8	35.4
Charlson Comorbidity Index
0	14.1	20.4	6.5	8.2	3.2	4.0
1–2	27.4	36.2	24.7	32.3	24.2	29.3
3–4	28.0	20.5	40.9	36.0	42.8	43.3
≥5	30.5	22.9	27.8	23.4	29.8	23.5
Specific comorbid condition
COPD	11.94	11.05	13.69	12.01	12.16	10.87
Diabetes	22.59	19.09	22.77	18.46	22.27	20.04
Hypertension	60.87	54.60	63.69	60.30	64.96	62.55
Renal failure	7.29	5.50	7.14	6.45	7.21	5.83
Obesity	13.68	13.06	11.76	13.98	11.77	11.84

Abbreviation: VATS, video-assisted thoracoscopic surgery.

Table 2 Baseline provider characteristics of the study cohort based on resection types

Provider characteristics	Wedge (n=8,416), %		Segmentectomy (n=1,788), %		Lobectomy (n=10,946), %
	Thoracotomy	VATS	Thoracotom	VATS	Thoracotomy	VATS
	(n=1,784)	(n=6,632)	y(n=672)	(n=1,116)	(n=5,870)	(n=5,076)
Teaching hospital	45.0	61.0	47.8	58.5	45.5	62.9
Geographic area of USA
Midwest	26.8	17.1	22.3	10.1	25.8	14.7
Northeast	12.1	32.9	11.3	33.1	11.0	28.8
South	47.4	36.1	47.8	43.4	46.9	43.0
West	13.7	13.9	18.6	13.4	16.3	13.6
Urban hospital	89.2	93.5	92.0	92.7	88.6	95.7
Hospital size
Small	3.3	4.5	3.0	4.1	3.2	4.4
Medium	12.8	12.7	14.1	12.6	12.7	11.6
Large	83.9	82.8	82.9	83.2	84.1	84.1
Hospital bed size
Bed size 1–300	28.7	19.4	22.0	23.2	23.0	17.2
Bed size 301–500	40.2	39.0	47.9	31.5	43.8	33.4
Bed size >500	31.1	41.7	30.1	45.3	33.2	49.4
Number of thoracic surgeries (2012–2014)
1–50	30.7	17.1	26.6	16.0	26.0	13.3
51–150	42.8	41.7	42.9	42.8	46.6	45.3
151–300	20.7	20.4	26.9	17.9	23.0	20.4
>300 surgeries	5.8	20.8	3.6	23.2	4.4	21.0
Cost type
Procedural	74.9	72.4	72.0	67.7	75.7	73.0
RCC	25.1	27.6	28.0	32.3	24.3	27.0
Physician specialty
Thoracic surgeon	63.1	64.4	65.0	65.1	63.3	64.1
Cardiac surgeon	19.8	13.6	16.7	9.3	20.1	13.4
General surgeon	10.3	14.3	10.0	13.4	9.1	11.6
Other	6.8	7.6	8.3	12.3	7.6	10.9

Abbreviations: VATS, video-assisted thoracoscopic surgery; RCC, ratio of cost to charge.

Figure 1 Patient-related factors associated with aALC.

Notes: Values represent odds ratios, and error bars represent 95% CIs. *Charlson Comorbidity Index.²⁵
Abbreviations: aALC, any air leak complication; CCI, Charlson Comorbidity Index.

Figure 2 Provider-related factors associated with aALC.

Note: Values represent odds ratios, and error bars represent 95% CIs.
Abbreviations: aALC, any air leak complication; VATS, video-assisted thoracoscopic surgery; RCC, ratio of cost to charge.

Figure 3 Association between air leak and hospital LOS (overall and by resection type).

Abbreviation: LOS, length of stay.

Figure 4 Association between air leak and ORT (overall and by resection type).

Abbreviation: ORT, operating room time.

Figure 5 Association between air leak and hospital costs (overall and by resection type).

Figure 6 Association between any air leak complications and mortality.

Table S1 List of diagnosis and procedure codes

ICD-9 code	Definition	Resection type	Approach
32.20	Thoracoscopic excision of lesion or tissue of lung	Wedge	VATS
32.28	Endoscopic excision or destruction of lesion or tissue of lung	Wedge	VATS
32.29	Other local excision or destruction of lesion or tissue of lung	Wedge	Open
32.30	Thoracoscopic segmental resection of lung	Segmentectomy	VATS
32.39	Other and unspecified segmental resection of lung	Segmentectomy	Open
32.41	Thoracoscopic lobectomy of lung	Lobectomy	VATS
32.49	Other lobectomy of lung	Lobectomy	Open
32.50	Thoracoscopic pneumonectomy	Pneumonectomy	VATS
32.59	Other and unspecified pneumonectomy	Pneumonectomy	Open
Primary outcomes (ICD-9 diagnosis codes) for any air leak complication
ICD-9 code	Definition	Complication type
512.2	Postoperative air leak	Air leak
512.84	Other air leak	Air leak
512.1	Iatrogenic pneumothorax	Pneumothorax
512.89	Other pneumothorax	Pneumothorax
Coding algorithm for Charlson comorbidities^Citation25
ICD-9 code		Comorbidities
410.x, 412.x		Myocardial infarction
428.x		Congestive heart failure
443.9, 441.x, 785.4, V43.4 procedure 38.48		Peripheral vascular disease
430.x–438.x		Cerebrovascular disease
290.x		Dementia
490.x–505.x, 506.4		Chronic pulmonary disease
710.0, 710.1, 710.4, 714.0–714.2, 714.81, 725.x		Rheumatic disease
531.x–534.x		Peptic ulcer disease
571.2, 571.4–571.6		Mild liver disease
250.0–250.3, 250.7		Diabetes without chronic complication
250.4–250.6		Diabetes with chronic complication
344.1, 342.x		Hemiplegia or paraplegia
582.x, 583-583.7, 585.x, 586.x, 588.x		Renal disease
140.x–172.x, 174.x–195.8, 200.x–208.x		Any malignancy, including lymphoma and leukemia, except malignant neoplasm of skin
456.0–456.21, 572.2–572.8		Moderate or severe liver disease
196.x–199.1		Metastatic solid tumor
042.x–044.x		AIDS/HIV

Note: Only select comorbidities based on bivariate analysis were included in the regression models.

Abbreviations: ICD-9, International Classification of Diseases, Ninth Revision; VATS, video-assisted thoracoscopic surgery.

DeyoRACherkinDCCiolMAAdapting a clinical comorbidity index for use with ICD-9-CM administrative databasesJ Clin Epidemiol19924566136191607900

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