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

Lung abscess is typically managed with antibiotics, but drainage procedures are sometimes performed when there is inadequate clinical response or when source control is needed. Real-world inpatient practice patterns remain incompletely described in contemporary U.S. data. Our aim was to evaluate national inpatient practice patterns, predictors of procedural intervention, and associated in-hospital outcomes and resource utilization among patients hospitalized with lung abscess managed conservatively, with bronchoscopic drainage, or with percutaneous drainage.

Using the National Inpatient Sample (NIS) (2016-2018), we identified adult (18 years and older) hospitalizations with a principal diagnosis of lung abscess [International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) J85.2]. Drainage procedures were identified using International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) codes and classified as bronchoscopic/endoscopic, percutaneous, or open. We used multivariable logistic regression to evaluate factors associated with drainage and negative binomial regression to model length of stay (LOS).

Among 907 eligible hospitalizations, 262 (28.9%) underwent drainage and 645 (71.1%) did not. Drainage included bronchoscopic drainage (n=169), percutaneous drainage (n=84), and rare open drainage (n=9). Compared with no drainage, the drainage group had longer LOS (7.4 vs. 5.8 days; P<0.001); mean day of first drainage was 2.42±2.5. Acute respiratory failure was associated with higher odds of drainage [adjusted odds ratio (aOR) 1.62, 95% confidence interval (CI): 1.01-2.63], while Medicaid (vs. Medicare) was associated with lower odds (aOR 0.41, 95% CI: 0.23-0.73). Any drainage was independently associated with longer LOS (aIRR 1.24, 95% CI: 1.13-1.36).

Drainage procedures were used in approximately one-third of adult lung abscess hospitalizations and were most commonly bronchoscopic. Utilization differed by illness severity and payer, and drainage was associated with longer LOS.