Trends in lung surgery: United States 1988 to 2002.
BACKGROUND
Reports on the temporal evolution in lung resection are limited. To elucidate temporal changes in the demographics of lung resections, we analyzed nationally representative data that were collected for the National Hospital Discharge Survey from 1988 to 2002.


METHODS
Data collected between 1988 and 2002 were analyzed. Patients with International Classification of Diseases, ninth revision, clinical modification, procedure codes for lung resection were included in the sample. Three 5-year time periods were created (1988 to 1992, 1993 to 1997, and 1998 to 2002) to simplify the temporal analysis. Changes in the prevalence of procedures, age, gender, race, length of care, mortality, disposition status, and distribution by hospital size were evaluated. Trends in procedure-related complications were analyzed.


RESULTS
Between 1988 and 2002, a total of 512,758 lung resections were performed. Comparing the earliest to the most recent time period, we found increases in the average age (61.1 years [range, 1 to 89 years] vs 63.2 years [range, 1 to 91 years], respectively), in the proportion of patients who were female (40.1% vs 49.6%, respectively), and in the proportion of Medicare/Medicaid patients (43.8% vs 49%/4.7% vs 6.7%, respectively). Decreases in the average length of stay (12.9 days [range, 1 to 358 days] vs 9.1 days [range, 1 to 175 days], respectively) and in the proportion of patients discharged to their primary residence (86% vs 79.5%, respectively) were seen. The proportion of patients who had undergone lobectomies compared to other types of lung resection increased. Mortality rates were 5% vs 5.4%, respectively, while the frequency of complications decreased.


CONCLUSIONS
We identified temporal changes in lung resection surgery that may help in the construction of health-care policies to address the changing needs of and financial burdens on the health-care system.
Memtsoudis
Stavros G
SG
Department of Anesthesiology, Perioperative, and Pain Medicine, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical Center, Boston, MA, USA. memtsoudiss@hss.edu
Besculides
Melanie C
MC
Zellos
Lambros
L
Patil
Namrata
N
Rogers
Selwyn O
SO
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006276:Health Facility Size / Q000191:economics / Q000706:statistics & numerical data; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007223:Infant; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008168:Lung / Q000601:surgery*; D008171:Lung Diseases / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D013510:Pulmonary Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D044469:Racial Groups; D012737:Sex Factors; D014481:United States / Q000453:epidemiology