In-hospital mortality following surgical lung biopsy for interstitial lung disease in the USA: 2000-2011

Rationale: Surgical lung biopsy can help to determine a specific diagnosis in interstitial lung disease, but has associated risks. Most currently available mortality data are derived from case series and may not be generalizable to broader populations. Objectives: We aimed to assess in-hospital mortality following surgical lung biopsy for interstitial lung disease in a national secondary care dataset from the United States. Methods: Data were obtained from the 2000-2011 Nationwide Inpatient Sample. Cases were identified using International Classification of Diseases (ICD-9-CM) codes for interstitial lung disease and surgical lung biopsies. Lung resections and cases of lung cancer were excluded. Weighted data were used to estimate numbers of biopsies nationwide and in-hospital mortality, and multivariable logistic regression was used to adjust for sex, age, geographic region, co-morbidity, type of operation and provisional diagnosis. Measurements and Main Results: We estimated there to be around 12,000 surgical lung biopsies performed annually for interstitial lung disease in the United States, two-thirds of which were performed electively. In-hospital mortality was 1.7% for elective procedures, but significantly higher for non-elective procedures (16.0%). Male sex, increasing age, increasing co-morbidity, open surgery and a provisional diagnosis of idiopathic pulmonary fibrosis or connective tissue disease related interstitial lung disease were risk factors for increased mortality. Conclusions: In-hospital mortality following elective surgical lung biopsy for interstitial lung disease is just under 2%, but significantly higher for non-elective procedures. Identified risk factors for death should be taken into account when counselling patients on whether to pursue a histological diagnosis

Critical care admission trends and outcomes in individuals with bronchiectasis in the UK

Background: There are limited data on admission trends and outcomes of individuals with bronchiectasis admitted to intensive care (ICU). Using national critical care data, we analysed admissions to ICU and estimated outcomes in terms of mortality in individuals with bronchiectasis and chronic obstructive pulmonary disease (COPD) admitted to ICU. Methods: Using data from the Intensive Care National Audit and Research Centre, admissions from bronchiectasis and COPD from 1 January 2009 to 31 December 2013 were extracted. Crude admission rates for bronchiectasis and COPD were calculated and Poisson regression was used to estimate unadjusted annual admission rate ratios. We investigated changes to length of stay on ICU, ICU mortality and in-hospital mortality during the study period. We also compared mortality rates in people with bronchiectasis and COPD aged 70 or above. Results: We found an annual increase of 8% (95% Confidence Interval [CI] 2-15) in the number of ICU admissions from bronchiectasis, whilst the yearly increase in ICU admissions from COPD was 1% (95% CI 0.3-2). ICU and in-hospital mortality was higher in individuals with bronchiectasis compared with those with COPD, especially in people aged 70 years or above. Conclusion: Admission to ICU in people with bronchiectasis are uncommon, but are increasing in frequency over time, and carries a substantial mortality rate. This needs to be considered allocating health care resources and planning respiratory services

Global incidence and mortality of idiopathic pulmonary fibrosis: a systematic review

Introduction: As idiopathic pulmonary fibrosis emerges as an important public health problem, there is a need to coordinate data on incidence and mortality globally. This study aims to systematically assess all available studies to investigate the global burden of disease. Methods: Medline and Embase databases were searched systematically for all population-based studies of incidence or mortality of idiopathic pulmonary fibrosis. Clinical case series and prevalence studies were excluded. The search was supplemented using Google search engine, hand-searching of references and conference abstracts. Data were extracted independently by two authors using a pre-specified proforma, with assessment of methodological quality. Results: 34 studies were identified providing data from 21 countries from 1968-2012. 28 studies reported incidence data, and eight reported mortality data. In studies from year 2000 onwards, we estimated a conservative incidence range of 3-9 cases per 100,000 per year for Europe and North America. Incidence was lower in East Asia and South America. The majority of studies showed an increase in incidence over time. Conclusions: The incidence of idiopathic pulmonary fibrosis is increasing worldwide, and rates are coming together across countries. Current data suggest incidence is similar to that of conditions such as stomach, liver, testicular and cervical cancers

Surgical lung biopsy for the diagnosis of interstitial lung disease in England: 1997-2008

Introduction: International guidelines and new targeted therapies for idiopathic pulmonary fibrosis have increased the need for accurate diagnosis of interstitial lung disease, which may lead to more surgical lung biopsies. This study aims to assess the risk of this procedure in patients from the United Kingdom. Methods: We used Hospital Episodes Statistics data from 1997-2008 to assess the frequency of surgical lung biopsy for interstitial lung disease in England. We identified cardiothoracic surgical patients using ICD-10 codes for interstitial lung disease and OPCS-4 codes for surgical lung biopsy. We excluded those with lung resections or lung cancer. We estimated in-hospital, 30-day and 90-day mortality following the procedure, and linked to cause of death using data from the Office of National Statistics. Results: We identified 2,820 patients with interstitial lung disease undergoing surgical lung biopsy during the 12 year period. The number of biopsies increased over the time period studied. In-hospital, 30-day and 90-day mortality were 1.7%, 2.4% and 3.9% respectively. Male sex, increasing age, increasing co-morbidity and open surgery were risk factors for mortality. Discussion: Surgical lung biopsy for interstitial lung disease has a similar mortality to lobectomy for lung cancer, and clinicians and patients should understand the likely risks involved

Increasing global mortality from idiopathic pulmonary fibrosis in the twenty-first century

Rationale: Recent evidence from the United Kingdom suggests that the number of deaths from idiopathic pulmonary fibrosis is increasing, although comparable international data are limited. Objectives: We aimed to collate death certification data from multiple countries to determine global trends in mortality from idiopathic pulmonary fibrosis. Methods: Data were obtained from the national statistics agencies of countries with relevant mortality records. Age-standardised mortality rates were calculated, and Poisson regression modelling was used to calculate rate ratios. Meta-analysis was used to calculate an overall estimate of mortality change over time. Measurements and Main Results: Ten countries provided mortality data on pulmonary fibrosis over a period from 1999 to 2012. Age-standardised mortality ranged between 4 and 10 per 100,000 population for the most recent years of data, being lowest in Sweden (4.68 per 100,000), Spain (5.38 per 100,000) and New Zealand (5.55 per 100,000), and highest in the UK (9.84 per 100,000 in England and Wales, 10.71 per 100,000 in Scotland) and Japan (10.26 per 100,000). Positive associations with male sex and increasing age were consistently observed across all countries. There was an overall 2-3% annual increase in mortality depending on codes used for classification – for broad codes, overall rate ratio 1.03 (95% confidence intervals 1.02-1.04, p<0.001), for narrow codes, overall rate ratio 1.02 (95% confidence intervals 1.01-1.03, p<0.001). Validation in a local cohort showed that idiopathic pulmonary fibrosis was recorded as the underlying cause of death in two-thirds of known cases and anywhere on the death certificate in 80% of cases. Conclusions: Mortality from idiopathic pulmonary fibrosis is increasing steadily worldwide, despite that fact that death certification will almost certainly underestimate true mortality. We estimate that there will be between 28000-65000 deaths in Europe and 13000-17000 deaths in the USA from idiopathic pulmonary fibrosis clinical syndrome in 2014. Variation between countries remains but is less than previously reported

Factors influencing treatment selection and thirty-day mortality following chemotherapy for people with small cell lung cancer: an analysis of national audit data

Background Thirty-day mortality after treatment for lung cancer is a measure of unsuccessful outcome and where treatment should have been avoided. Guidelines recommend offering chemotherapy to individuals with small cell lung cancer (SCLC) who have poorer performance status (PS) because of its high initial response rate. However, this comes with an increased risk of toxicity and early death. We quantified real-world 30-day mortality in SCLC following chemotherapy, established the factors associated with this and compared these to the factors that influence receipt of chemotherapy. Methods We used linked national English datasets to define the factors associated with both receiving chemotherapy and 30-day mortality following chemotherapy. Results We identified 3,715 people diagnosed with SCLC, of which 2,235 (60.2%) received chemotherapy. There were 174 (7.8%) deaths within 30 days of chemotherapy. The adjusted odds of receiving chemotherapy decreased with older age, worsening PS and increasing comorbidities. Thirty-day mortality was independently associated with poor PS (PS 2 vs PS 0 adjusted OR 3.75 95% CI 1.71-8.25) and stage (extensive vs limited adjusted OR 1.68 95% CI 1.03-2.74) but in contrast was not associated with increasing age. Both chemotherapy administration and 30-day mortality varied by hospital network.Conclusions To reduce variation in chemotherapy administration predictors of 30-day mortality could be used as an adjunct to improve sub-optimal patient selection. We have quantified 30-day mortality risk by the two independently associated factors, PS and stage, so that patients and clinicians can make better informed decisions about the potential risk of early death following chemotherapy

Investigating the detection of adverse drug events in a UK general practice electronic health-care database

Data-mining techniques have frequently been developed for Spontaneous reporting databases. These techniques aim to find adverse drug events accurately and efficiently. Spontaneous reporting databases are prone to missing information,under reporting and incorrect entries. This often results in a detection lag or prevents the detection of some adverse drug events. These limitations do not occur in electronic healthcare databases. In this paper, existing methods developed for spontaneous reporting databases are implemented on both a spontaneous reporting database and a general practice electronic health-care database and compared. The results suggests that the application of existing methods to the general practice database may help find signals that have gone undetected when using the spontaneous reporting system database. In addition the general practice database provides far more supplementary information, that if incorporated in analysis could provide a wealth of information for identifying adverse events more accurately