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

BACKGROUND: The development of targeted therapies for idiopathic pulmonary fibrosis has increased the need for accurate diagnosis of interstitial lung disease, which may lead to more patients being offered surgical lung biopsy. However, this procedure has associated risks. AIMS AND OBJECTIVES: We sought to explore the mortality risk of surgical lung biopsy for interstitial lung disease using national data from the UK. 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 the in-hospital, 30-day and 90-day mortality following the procedure, as well as re-admissions and cause of death, using linked Office of National Statistics data, adjusting for age, sex, co-morbidity, level of deprivation, type of operation and provisional diagnosis. RESULTS: We identified 2,937 patients with interstitial lung disease undergoing surgical lung biopsy during the 12 year period, and the number of biopsies increased over the time period studied. In-hospital, 30-day and 90-day mortality were 1.7%, 2.5% and 4.0% respectively. The most common cause of death for all cases was interstitial lung disease. 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. These data will aid decision-making for both clinicians and patients when considering the procedure.