Practice patterns and inpatient outcomes in lung abscess: a cross sectional study

Area of Science:

• Pulmonology
• Infectious Diseases
• Health Services Research

Background:

• Lung abscess management typically involves antibiotics, with drainage reserved for refractory cases or when source control is critical.
• Contemporary U.S. inpatient practice patterns for lung abscess management, including drainage procedures, are not well-documented.
• This study investigates national inpatient practices for lung abscess, focusing on procedural interventions and outcomes.

Purpose of the Study:

• To analyze national inpatient practice patterns for lung abscess management in the U.S.
• To identify predictors of procedural drainage interventions in lung abscess patients.
• To assess in-hospital outcomes and resource utilization associated with different management strategies.

Main Methods:

• Utilized the National Inpatient Sample (NIS) database from 2016-2018 for adult hospitalizations with a principal diagnosis of lung abscess (ICD-10-CM J85.2).
• Classified drainage procedures as bronchoscopic/endoscopic, percutaneous, or open using ICD-10-PCS codes.
• Employed multivariable logistic regression to determine factors associated with drainage and negative binomial regression for length of stay (LOS).

Main Results:

• Of 907 eligible hospitalizations, 28.9% underwent drainage (bronchoscopic: 169, percutaneous: 84, open: 9).
• Acute respiratory failure increased odds of drainage (aOR 1.62), while Medicaid insurance decreased odds (aOR 0.41) compared to Medicare.
• Drainage procedures were associated with a longer LOS (7.4 vs. 5.8 days; P<0.001), with an average first drainage day of 2.42.

Conclusions:

• Drainage procedures, predominantly bronchoscopic, were employed in approximately one-third of adult lung abscess hospitalizations.
• The utilization of drainage varied based on patient illness severity and insurance payer.
• Procedural drainage was independently associated with an increased length of hospital stay.