Increasing Numbers and Reported Adverse Events in Patients with Lung Cancer Undergoing Inpatient Lung Biopsies: A Population-Based Analysis

Mitchell S. von Itzstein, Arjun Gupta, Kristin C. Mara, Sahil Khanna, David E. Gerber

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Introduction: The use of molecular biomarkers to guide lung cancer management has led to increasing frequency and amounts of tissue required for repeat lung biopsies. While patient safety and reporting of adverse events has been increasingly emphasized in recent decades, the safety of lung biopsies in patients with lung cancer has only been studied in small cohorts. We therefore analyzed adverse events in patients with lung cancer undergoing lung biopsies in the National Hospital Discharge Survey (NHDS) database. Methods: Data were abstracted using ICD-9 lung cancer diagnosis (162.X) and lung biopsy procedure codes (33.20, 33.24, 33.25, 33.26, 33.27, 33.28) from 2001 to 2010. Agency for Healthcare Research and Quality (AHRQ) Patient-Safety Indicators (PSI) were used to identify hospital-acquired adverse events. Weighted analyses were performed using SAS version 9.4. Results: A total of 540,747 patients were included for analysis. The number of biopsies increased over time, from 51,221 in 2001, to 63,239 in 2010 (P < 0.001). Overall, 159,683 (30%) patients suffered ≥ 1-PSI event during their hospitalization. Incidence of PSI varied by biopsy type: bronchoscopic (26%), percutaneous (34%), surgical (39%). The proportion of patients with ≥ 1 PSI event increased from 24% in 2001 to 38% in 2010 (P < 0.001). Patients with ≥ 1 PSI had longer length of stay (mean, 11.6 vs 8.1 days; P < 0.001) and higher in-hospital mortality (adjusted odds ratio, 5.9, 95% CI 3.9–8.9; P < 0.001). Conclusions: The frequency of lung biopsies performed and rate of documented adverse events in hospitalized lung cancer patients have increased. These findings have policy, funding, research, and practice implications.

Original languageEnglish (US)
Pages (from-to)593-599
Number of pages7
Issue number5
StatePublished - Oct 1 2019
Externally publishedYes

Bibliographical note

Funding Information:
Funded in part by a National Cancer Institute Midcareer Investigator Award in Patient-Oriented Research (K24 CA201543-01; to DEG). This work is not under consideration for publication elsewhere. If accepted, this work will not be published elsewhere without written consent of the copyright-holder.

Funding Information:
The authors thank Helen Mayo, MLS from the UT Southwestern Medical Library for assistance with literature searches. The authors thank Ms. Dru Gray for assistance with manuscript preparation.

Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.


  • Biopsy
  • Complications
  • Lung cancer
  • Outcomes
  • Pneumothorax


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