The clinical and economic burden of significant bleeding during lung resection surgery: A retrospective matched cohort analysis of real-world data

Objectives: The objective of this retrospective study was to quantify the clinical and economic burden of significant bleeding in lung resection surgery in the US.Methods: This study utilized 2009-2012 data from the Premier Perspective Database(TM). Adult patients with primary pulmonary lobectomy or segmentectomy procedures were categorized by the surgical approach (VATS vs open) and primary diagnosis (primary or metastatic lung cancer vs non-lung cancer). Patients requiring 3 units of blood products with at least 1 unit of PRBCs: significant bleeding cohort; those requiring <3 units: non-significant bleeding cohort; and those not requiring blood products: no bleeding cohort. A matched cohort analysis was performed between the significant bleeding and the no bleeding cohort using matching variables: hospital, lung cancer diagnosis, year of surgery, APR-DRG severity score, procedure type and approach, age, and gender.Results: The All-patient cohort comprised 21,429 patients: 213 significant bleeding; 2,780 non-significant bleeding; and 18,436 no bleeding. Overall incidence of significant chest bleeding was 0.99%. Patients from significant bleeding cohort and non-significant bleeding cohort had 2.5 days and 2 days (p<0.0001) longer length of stay in the hospital compared to those in the no bleeding cohort, respectively. Overall, hospital costs for significant bleeding cohort were higher than no bleeding cohort for those who were covered under Medicare ($59,871 vs $23,641), were 76 years of age ($64,010 vs $24,243), had greater severity of illness ($97,813 vs $51,871) and underwent open segmentectomy ($74,220 vs $21,903). Hospital costs for significant bleeding cohort and non-significant bleeding were significantly higher ($11,589 and $5,280, respectively, p<0.0001) than no bleeding cohort.Conclusions: Although significant bleeding during lung resection surgery is rare, patients with such complication could stay longer at the hospital and cost an average of $13,103 more than those without.