Dyas Adam R, Stuart Christina M, Fei Yizhou, Cotton Jake L, Colborn Kathryn L, Weyant Michael J, Randhawa Simran K, David Elizabeth A, Mitchell John D, Scott Christopher D, Meguid Robert A
Department of Surgery, University of Colorado, Aurora, CO, USA.
Surgical Outcomes and Applied Research, University of Colorado, Aurora, CO, USA.
J Thorac Dis. 2024 Feb 29;16(2):1141-1150. doi: 10.21037/jtd-23-1724. Epub 2024 Feb 22.
Surgical diagnostic lung biopsy (DLB) is performed to guide the management of pulmonary disease with unclear etiology. However, the utilization of surgical DLB in critically ill patients remains unclear. The purpose of this study was to determine if patient preoperative disposition impacts complication rates after DLB.
This was retrospective cohort study using electronic health record (EHR) data at one academic institution [2013-2021]. Patients who underwent DLB were identified using current procedural terminology (CPT) codes and cohorted based on preoperative disposition. The primary outcome was 30-day mortality; secondary outcomes were overall morbidity, individual complications, and changes to medical therapy. Complication rates were compared using chi-squared tests, Fisher's exact tests, or analysis of variance (ANOVA). Multivariable logistic regression was performed to generate risk-adjusted odds ratios (ORs) for each complication.
Of 285 patients, 238 (83.5%) presented from home, 26 (9.1%) from inpatient floor units, and 21 (7.4%) from intensive care units (ICUs). Patients requiring ICU had the highest 30-day rates of mortality, overall morbidity, and all individual complications (all P<0.05). After risk adjustment, non-ICU inpatients had higher odds of postoperative ventilator use, prolonged ventilation, and ICU need than outpatients (all P<0.05). Preoperative ICU disposition was associated with increased OR of 30-day mortality [OR, 70.92; 95% confidence interval (CI): 5.55-906.32] and overall morbidity (OR, 7.27; 95% CI: 1.93-27.42) compared to patients with other preoperative dispositions. There were no differences in changes to medical therapy between the cohorts.
Patients requiring ICU before DLB had significantly higher risk-adjusted rates of mortality and postoperative complications than outpatients and other inpatients. A clear benefit from tissue diagnosis should be defined prior to performing DLB on critically ill patients.
进行外科诊断性肺活检（DLB）以指导病因不明的肺部疾病的管理。然而，外科DLB在重症患者中的应用情况仍不明确。本研究的目的是确定患者术前状态是否会影响DLB后的并发症发生率。
这是一项使用某学术机构[2013 - 2021年]电子健康记录（EHR）数据的回顾性队列研究。使用当前程序术语（CPT）代码识别接受DLB的患者，并根据术前状态进行分组。主要结局是30天死亡率；次要结局是总体发病率、个体并发症以及药物治疗的变化。使用卡方检验、Fisher精确检验或方差分析（ANOVA）比较并发症发生率。进行多变量逻辑回归以生成每种并发症的风险调整比值比（OR）。
在285例患者中，238例（83.5%）来自家中，26例（9.1%）来自住院病房，21例（7.4%）来自重症监护病房（ICU）。需要入住ICU的患者30天死亡率、总体发病率和所有个体并发症的发生率最高（所有P<0.05）。风险调整后，非ICU住院患者术后使用呼吸机、通气时间延长和需要入住ICU的几率高于门诊患者（所有P<0.05）。与其他术前状态的患者相比，术前入住ICU与30天死亡率[OR，70.92；95%置信区间（CI）：5.55 - 906.32]和总体发病率（OR，7.27；95% CI：1.93 - 27.42）的OR增加相关。各队列之间在药物治疗变化方面没有差异。
DLB前需要入住ICU的患者经风险调整后的死亡率和术后并发症发生率明显高于门诊患者和其他住院患者。在对重症患者进行DLB之前，应明确组织诊断的明确益处。
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