What is it about?
Diagnosing people with interstitial lung disease such as idiopathic pulmonary fibrosis can be difficult. Although x-rays and scans can help, sometimes doctors ask for a biopsy - a sample of the lung, obtained via a small operation - to help work out what is going on. While this can help, it can be risky in people who are breathless whose lungs are not working well. We looked at the likelihood of dying in-hospital after a lung biopsy for suspected interstitial lung disease, using data from hospitals in the United States. We identified procedures using administrative codes for common types of lung disease and surgical lung biopsies. Around two thirds of biopsies were performed electively (planned procedures) while a third were performed non-electively (urgent or emergency cases). The chance of dying after an elective operation was less than 1 in 50, but it was nearly 1 in 6 for a non-elective operation. Older male patients with other medical problems tended to have a higher risk of dying. For elective procedures, the chance of dying was as low as 1 in 250 for younger patients without any other medical problems, whereas this was up to 1 in 10 for elderly males with other medical problems.
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Why is it important?
It is widely known that surgical lung biopsies can be risky for certain patients with interstitial lung disease, but most data so far has been from individual hospitals, and these data might reflect the practice of interested specialists. The licencing of new medications to treat idiopathic pulmonary fibrosis may increase the desire for accurate diagnosis and lead to more surgery being offered. Clinicians therefore need information to help guide them when discussing surgery with individual patients, and this data may help when considering the balance between risks and benefits.
Perspectives
The benefit of this work is the large number of patients included, from a representative data source from across the USA. This should overcome some of the biases of case series from individual hospitals. However, a limitation of using such a large database is potential uncertainty regarding the cases included, as there is less information available for each procedure. In particular, data that might impact on risks such as lung function test results or the use of certain medications was not available, and these factors should be taken into account when discussing risks with individual patients. However, overall the data seem consistent with that reported elsewhere, and provide a useful starter for those contemplating surgery. The finding of considerably higher mortality in those undergoing non-elective surgery has been noted before, and should make clinicians think carefully before offering an 'emergency' lung biopsy in very poorly patients, when it may lead to harm with limited benefit.
Dr John Hutchinson
University of Nottingham
Read the Original
This page is a summary of: In-Hospital Mortality after Surgical Lung Biopsy for Interstitial Lung Disease in the United States. 2000 to 2011, American Review of Respiratory Disease, May 2016, American Thoracic Society,
DOI: 10.1164/rccm.201508-1632oc.
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