Factors Associated with Hospital Length of Stay and Adverse Events Following Percutaneous Ablation of Lung Tumors

To explore the association between risk factors established in the surgical literature and hospital length of stay (HLOS), adverse events, and hospital readmission within 30 days after percutaneous image-guided thermal ablation (IGTA) of lung tumors.

Materials and Methods:

This bi-institutional retrospective cohort study included 131 consecutive adult patients (67 male, 51%; median age, 65 years) with 180 primary or metastatic lung tumors treated in 131 sessions (74 cryoablation, 57 microwave ablation) from 2006-2019. Age-adjusted Charlson Comorbidity Index (CCI), sex, performance status, smoking status, chronic obstructive pulmonary disease (COPD), primary lung cancer versus pulmonary metastases, number of tumors treated per session, maximum axial tumor diameter, ablation modality, number of pleural punctures, anesthesia type, pulmonary artery to aorta ratio, lung densitometry, sarcopenia, and adipopenia were evaluated. Associations between risk factors and outcomes were assessed using uni- and multivariable generalized linear models.  

Results:

In univariable analysis, HLOS was associated with current smoking (incident rate ratio (IRR) 4.54 [1.23-16.8], p=.02), COPD (IRR 3.56 [1.40-9.04], p=.01), cryoablations with ≥3 pleural punctures (IRR 3.13 [1.07-9.14], p=.04), general anesthesia (IRR 10.8 [4.18-27.8], p< .001), and sarcopenia (IRR 2.66 [1.10-6.44], p=.03). After multivariable adjustment, COPD (3.56 [1.57-8.11], p=.003) and general anesthesia (IRR 12.1 [4.39-33.5], p< .001) were the only risk factors associated with longer HLOS. No associations were observed between risk factors and adverse events in multivariable analysis. Tumors treated per session were associated with risk of hospital readmission (p=.03).

Conclusion:

Pre-procedural risk factors from the surgical literature may aid in risk stratification for percutaneous IGTA of lung tumors.