Lung Lobectomy Surgical Approach and Resource Utilization Differ by Anatomic Lobe in a Statewide Discharge Registry

Overview

Journal J Thorac Dis

Publisher AME Publishing Company

Specialty Pulmonary Medicine

Date 2022 Sep 8

PMID 36071767

Authors

Daniel T DeArmond

Mohammed S Rahman

Stewart R Miller

Christian P Jacobsen

Scott B Johnson

Duy C Nguyen

Nitin A Das

Affiliations

Soon will be listed here.

Abstract

Background: Anatomic lobe-specific differences with respect to pulmonary lobectomy have been suggested in the thoracic surgery literature but hard data has been lacking in larger population studies in part due to coding systems that do not distinguish pulmonary lobectomy by anatomic lobe. International Classification of Diseases, Tenth Revision (ICD-10) procedure codes, adopted in the United States in 2015, may provide novel methodologic accessibility for pulmonary lobectomy studies as they classify lobectomy operations by specific anatomic lobe. We queried the Texas Inpatient Public Use Data File (TPUDF) ICD-10 codes for both open and endoscopic approach lobectomy with a specific view to differences based on anatomic lobes.

Methods: Between fourth fiscal quarter (Q4) 2015 and Q4 2017, all pulmonary lobectomy operations performed in Texas state-licensed hospitals were identified by querying the TPUDF for ICD-10 procedure codes for pulmonary lobectomy as classified by anatomic lobe. Surgical approach, additional procedures and diagnosis codes, length of hospital stay (LOS), and discharge status were recorded with aggregate values undergoing statistical analysis.

Results: Right and left upper versus lower lobe resections were more prevalent however minimally invasive surgery was less commonly performed for upper than right lower lobectomy. LOS, irrespective of surgical approach, was longer for upper versus lower lobe resection as was need for transfer to additional inpatient facilities. LOS was longer and need for additional surgical or procedural interventions days after the primary procedure of lobectomy was greater for right versus left upper lobe resection, suggesting some differential properties of the right versus left pleural space.

Conclusions: The marked clinical differences between anatomic lobes in the setting of pulmonary lobectomy observed in this study have the potential to translate to differences in expected hospital and health system costs and surgeon time-expenditure and experience premium that currently have no mechanism for their accounting. These findings highlight the value of ICD-10 coding for analysis of pulmonary lobectomy in administrative databases and suggest a possible path to more informed patient counseling and equitable hospital and surgeon reimbursement based on payment adjustment by anatomic lobe in pulmonary lobectomy operations.

References

Caleffi-Pereira M, Pletsch-Assuncao R, Cardenas L, Santana P, Ferreira J, Iamonti V . Unilateral diaphragm paralysis: a dysfunction restricted not just to one hemidiaphragm. BMC Pulm Med. 2018; 18(1):126. PMC: 6090915. DOI: 10.1186/s12890-018-0698-1. View

Tong B, Kim S, Kosinski A, Onaitis M, Boffa D, Habib R . Penetration, Completeness, and Representativeness of The Society of Thoracic Surgeons General Thoracic Surgery Database for Lobectomy. Ann Thorac Surg. 2018; 107(3):897-902. DOI: 10.1016/j.athoracsur.2018.07.059. View

Brasel K, Lim H, Nirula R, Weigelt J . Length of stay: an appropriate quality measure?. Arch Surg. 2007; 142(5):461-5. DOI: 10.1001/archsurg.142.5.461. View

Petersen R, Hansen H . Learning curve associated with VATS lobectomy. Ann Cardiothorac Surg. 2013; 1(1):47-50. PMC: 3741706. DOI: 10.3978/j.issn.2225-319X.2012.04.05. View

McKenna Jr R . Complications and learning curves for video-assisted thoracic surgery lobectomy. Thorac Surg Clin. 2008; 18(3):275-80. DOI: 10.1016/j.thorsurg.2008.04.004. View

Elefteriades J, Singh M, Tang P, Siegel M, Kenney B, Pandey A . Unilateral diaphragm paralysis: etiology, impact, and natural history. J Cardiovasc Surg (Torino). 2008; 49(2):289-95. View

Bryan D, Ferguson M, Antonoff M, Backhus L, Birdas T, Blackmon S . Consensus for Thoracoscopic Left Upper Lobectomy-Essential Components and Targets for Simulation. Ann Thorac Surg. 2020; 112(2):436-442. DOI: 10.1016/j.athoracsur.2020.06.152. View

Yan T, Cao C, DAmico T, Demmy T, He J, Hansen H . Video-assisted thoracoscopic surgery lobectomy at 20 years: a consensus statement. Eur J Cardiothorac Surg. 2013; 45(4):633-9. DOI: 10.1093/ejcts/ezt463. View

Clark J, Utter G, Nuno M, Romano P, Brown L, Cooke D . ICD-10-CM/PCS: potential methodologic strengths and challenges for thoracic surgery researchers and reviewers. J Thorac Dis. 2019; 11(Suppl 4):S585-S595. PMC: 6465427. DOI: 10.21037/jtd.2019.01.86. View

10.

Sawada S, Komori E, Yamashita M . Evaluation of video-assisted thoracoscopic surgery lobectomy requiring emergency conversion to thoracotomy. Eur J Cardiothorac Surg. 2009; 36(3):487-90. DOI: 10.1016/j.ejcts.2009.04.004. View

11.

Kinsey C, San Jose Estepar R, Zhao Y, Yu X, Diao N, Heist R . Invasive adenocarcinoma of the lung is associated with the upper lung regions. Lung Cancer. 2014; 84(2):145-50. PMC: 4004700. DOI: 10.1016/j.lungcan.2014.02.002. View

12.

Ferguson M, Bennett C . Identification of Essential Components of Thoracoscopic Lobectomy and Targets for Simulation. Ann Thorac Surg. 2017; 103(4):1322-1329. DOI: 10.1016/j.athoracsur.2016.12.021. View

13.

URSCHEL Jr H, Razzuk M . Median sternotomy as a standard approach for pulmonary resection. Ann Thorac Surg. 1986; 41(2):130-4. DOI: 10.1016/s0003-4975(10)62652-5. View

14.

Kozower B, OBrien S, Kosinski A, Magee M, Dokholyan R, Jacobs J . The Society of Thoracic Surgeons Composite Score for Rating Program Performance for Lobectomy for Lung Cancer. Ann Thorac Surg. 2016; 101(4):1379-86. DOI: 10.1016/j.athoracsur.2015.10.081. View

15.

Gavrielov-Yusim N, Friger M . Use of administrative medical databases in population-based research. J Epidemiol Community Health. 2013; 68(3):283-7. DOI: 10.1136/jech-2013-202744. View

16.

SILVER A, ESPINAS E, BYRON F . The fate of the postresection space. Ann Thorac Surg. 1966; 2(3):311-36. DOI: 10.1016/s0003-4975(10)66583-6. View

17.

Niyirora J . Entropic measures of complexity in a new medical coding system. BMC Med Inform Decis Mak. 2021; 21(1):124. PMC: 8034175. DOI: 10.1186/s12911-021-01485-y. View

18.

Yamada Y, Yamada M, Chubachi S, Yokoyama Y, Matsuoka S, Tanabe A . Comparison of inspiratory and expiratory lung and lobe volumes among supine, standing, and sitting positions using conventional and upright CT. Sci Rep. 2020; 10(1):16203. PMC: 7530723. DOI: 10.1038/s41598-020-73240-8. View

19.

Laroche C, Mier A, Moxham J, Green M . Diaphragm strength in patients with recent hemidiaphragm paralysis. Thorax. 1988; 43(3):170-4. PMC: 461156. DOI: 10.1136/thx.43.3.170. View

20.

Seder C, Salati M, Kozower B, Wright C, Falcoz P, Brunelli A . Variation in Pulmonary Resection Practices Between The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons General Thoracic Surgery Databases. Ann Thorac Surg. 2016; 101(6):2077-84. DOI: 10.1016/j.athoracsur.2015.12.073. View