Epidemiology and outcomes of hospitalized patients with lung cancer and acute respiratory failure: National inpatient database analysis.

Abstract

Background: Acute respiratory failure (ARF) is common in lung cancer patients and could be related to tumor progression, effects of treatment, or comorbid illnesses. Data on the short-term outcomes of these patients, especially those requiring invasive mechanical ventilation (IMV), remain scarce.

Methods: The National Inpatient Sample database (2016-2019) was used to identify lung cancer admissions using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. ARF and IMV subgroups within lung cancer hospitalizations were identified using ICD-10-CM codes. Baseline variables were analyzed using χ2 test for categorical data and adjusted Wald tests for continuous data. Results were reported as percentages and mean ± standard deviation.

Results: We identified 581,805 (24.7%) admissions for lung cancer with ARF during the study period. All-cause inpatient mortality was six times higher in lung cancer admissions with ARF compared to the non-ARF cohort (18.50% vs. 3.19%; P < 0.001). Similarly, lung cancer admissions with ARF that required IMV had significantly higher mortality compared to the cohort that did not require IMV (44.86% vs. 12.59%; P < 0.001). Lung cancer admissions with ARF requiring IMV had longer stay in the hospital (11.19 vs. 6.69 days; P < 0.001). The total hospitalization cost was more than two times higher for lung cancer admissions with ARF requiring IMV ($40,024.2 vs. $16,260.5; P < 0.001).

Conclusions: In this largest study to date, we provide insight into the incidence and outcomes of lung cancer admissions with ARF. Lung cancer admissions with ARF, especially those requiring IMV, were associated with worse outcomes, longer hospital stays, and significantly higher healthcare costs. Compared to historical data, the outcomes in this large database have improved.