Hospital variation in the development of respiratory failure after pulmonary lobectomy: A national analysis

Respiratory failure after pulmonary lobectomy is a serious complication associated with increased mortality in limited institutional series. The present study evaluated factors associated with respiratory failure and sought to ascertain the presence of interhospital variation.

The 2016-2018 Nationwide Readmissions Database was queried to identify elective adult (≥18 years) hospitalizations for pulmonary lobectomy with the diagnosis of lung cancer. Multi-level, mixed-effects models were developed to identify factors associated with respiratory failure and evaluate its associated in-hospital mortality, length of stay, and hospitalization costs. Random effects were predicted with Bayesian methodology and used to rank hospitals by increasing respiratory failure risk attributable to each institution.

Of an estimated 70,992 patients, 8.0% developed respiratory failure. Compared to those without, patients with respiratory failure were on average older and less commonly female. After multivariable adjustment, coagulopathy, pulmonary circulation disorders, and open operative approach were associated with increased odds of respiratory failure. However, relative to right upper, right middle resections were associated with a reduction in likelihood of respiratory failure. Approximately 27% of the variance in respiratory failure was attributable to the hospital-level effects, with baseline risk ranging from 0.1% to 20.7%. Notably, respiratory failure was associated with increased mortality, longer length of stay, and greater hospitalization costs.

The present work identified several factors associated with respiratory failure after lobectomy and found it to be associated with inferior clinical outcomes and greater resource use. We noted significant interhospital variation in the development of respiratory failure, suggesting the need for systemic quality improvement efforts.