Preventable Patient Safety Indicators After Lung Resection: Outcomes and Cost at a Large High-Volume Institution

BackgroundPatient Safety Indicators (PSIs) are quality metrics developed by the Agency for Healthcare Research and Quality (AHRQ) to identify potentially preventable postoperative complications. The rate of PSIs after lung resection remains poorly defined.MethodsWe retrospectively reviewed our institutional database for all lung resection patients age ≥16 from 2014 to 2024. Patient Safety Indicators evaluated were PSI-9 (hemorrhage/hematoma), PSI-10 (acute kidney injury requiring dialysis), PSI-12 (peri-operative pulmonary embolism [PE] or deep vein thrombosis [DVT]), and PSI-13 (post-operative sepsis). The primary outcome was the incidence of preventable PSIs following lung resection. Secondary outcomes included clinical predictors of PSI, short-term outcomes by PSI status, and PSI-related costs.ResultsAmong 2701 lung resection patients, 35 (1.29%) experienced at least one PSI, totaling 43 PSI events (1.59%). Patient Safety Indicator patients were more often male (65.7% vs 48.3%, P = .04), had higher comorbidity burden (Charlson-Deyo 3+: 97.1% vs 73.5%, P = .02), and more frequently had prior lung cancer (80.0% vs 52.3%, P = .001). Patient Safety Indicator patients had higher 30-day mortality (11.4% vs 1.2%, P < .001). Logistic regression identified male sex (aOR 2.20 [1.08-4.46], P = .03) and prior lung cancer (aOR 2.95 [1.22-7.12], P = .02) as independent predictors of PSI. After review, 37 PSIs were classified as preventable or possibly preventable (1.37%), generating an estimated cost burden of $983,059 and largely driven by PSI-13 sepsis events.ConclusionAlthough PSIs after lung resection are infrequent, focus on preventing post-operative adverse outcomes should remain paramount. Targeted strategies to prevent these preventable complications can help improve outcomes and provide a significant cost-saving opportunity.