Risk-Adjusted Discrete Increases in Length of Stay by Complication Following Anatomic Lung Resection: An Analysis of 32,133 Cases Across the United States.

Abstract

Prior studies have associated morbidity following anatomic lung resection with prolonged postoperative length of stay, however, each complication's individual impact on length-of-stay as a continuous variable has not been studied. The purpose of this study was to determine the risk-adjusted increase in length-of-stay associated with each individual postoperative complications following anatomic lung resection. Patients who underwent anatomic lung resection cataloged in the prospectively collected American College of Surgeons National Surgical Quality Improvement Program participant use file, 2005-2018, were targeted. The association between preoperative characteristics, postoperative complications and length-of-stay in days was tested. A negative binomial model adjusting for the effect of preoperative characteristics and 18 concurrent postoperative complications was used to generate incidence rate ratios. This model was fit to generate risk-adjusted increases in length-of-stay by complication. Of 32,133 patients, 5,065 patients (15.8%) experienced at least one post-operative complication. The most frequent complications were pneumonia (n = 1,829, 5.7%), the need for transfusion (n = 1,794, 5.6%), and unplanned reintubation (n = 1,064, 3.3%). The occurrence of each of the 18 individual complications was associated with significantly increased length-of-stay. This finding persisted after risk-adjustment, with the greatest risk-adjusted increases being associated with prolonged ventilation (+17.4 days), followed by septic shock (+17.2 days), acute renal failure (+16.5 days), and deep surgical site infection (+13.2 days). All 18 postoperative complications studied following anatomic lung resection were associated with significant risk-adjusted increases in length-of-stay, ranging from an increase of 17.4 days with prolonged ventilation to 2.6 days following the need for transfusion.