INVASIVE MECHANICAL VENTILATION DURING TERMINAL LUNG CANCER HOSPITALIZATIONS: NATIONAL PATTERNS AND INPATIENT BURDEN
Author(s)
Yue Suo, MSc1, Yi Yang, PhD2, YINGYAO CHEN, PhD2, Shenglan Tang, MD, PhD1;
1Duke University, Duke Global Health Institute, Durham, NC, USA, 2Fudan University, School of Public Health, Shanghai, China
1Duke University, Duke Global Health Institute, Durham, NC, USA, 2Fudan University, School of Public Health, Shanghai, China
OBJECTIVES: Invasive mechanical ventilation provides limited clinical benefit for patients with terminal cancer and is generally not recommended. However, it continues to be used in routine inpatient care. This study aimed to estimate its national use during terminal hospitalizations among lung cancer patients and examine associated length of stay, inpatient charges, and variation across patient and hospital characteristics.
METHODS: Using the 2018-2019 National Inpatient Sample data, we identified terminal hospitalizations among patients with lung cancer, defined as in-hospital death. Lung cancer diagnosis was identified using ICD-10-CM codes, and invasive mechanical ventilation was identified using ICD-10-PCS procedure codes, categorized by duration (<24 hours, 24-96 hours, >96 hours). National estimates were generated using discharge-level survey weights. Length of stay and total inpatient charges were compared between hospitalizations with and without mechanical ventilation. Subgroup analyses were conducted by patient age, primary payer, hospital region, and teaching status.
RESULTS: An estimated 30,680 terminal lung cancer hospitalizations were identified, in which 27.9% involved invasive mechanical ventilation. Mechanical ventilation was distributed across duration categories, with 10.4% of hospitalizations involving ventilation for <24 hours, 9.8% for 24-96 hours, and 8.4% for >96 hours. Mean length of stay was longer among ventilated hospitalizations compared with non-ventilated hospitalizations (8.1 vs. 6.3 days). Mean inpatient charges were higher for ventilated hospitalizations ($153,005) than for those without ventilation ($62,989). In addition, mechanical ventilation use and associated inpatient resource use varied across hospitals, with higher use observed in teaching hospitals.
CONCLUSIONS: A substantial proportion of hospitalized lung cancer patients at the end of life received invasive mechanical ventilation, which was associated with longer hospital stays and higher inpatient costs. Variation across patient and hospital characteristics suggests heterogeneity in end-of-life inpatient care practices. These findings underscore the importance of focusing on how clinical practice during terminal hospitalizations aligns with guideline-recommended approaches to end-of-life care.
METHODS: Using the 2018-2019 National Inpatient Sample data, we identified terminal hospitalizations among patients with lung cancer, defined as in-hospital death. Lung cancer diagnosis was identified using ICD-10-CM codes, and invasive mechanical ventilation was identified using ICD-10-PCS procedure codes, categorized by duration (<24 hours, 24-96 hours, >96 hours). National estimates were generated using discharge-level survey weights. Length of stay and total inpatient charges were compared between hospitalizations with and without mechanical ventilation. Subgroup analyses were conducted by patient age, primary payer, hospital region, and teaching status.
RESULTS: An estimated 30,680 terminal lung cancer hospitalizations were identified, in which 27.9% involved invasive mechanical ventilation. Mechanical ventilation was distributed across duration categories, with 10.4% of hospitalizations involving ventilation for <24 hours, 9.8% for 24-96 hours, and 8.4% for >96 hours. Mean length of stay was longer among ventilated hospitalizations compared with non-ventilated hospitalizations (8.1 vs. 6.3 days). Mean inpatient charges were higher for ventilated hospitalizations ($153,005) than for those without ventilation ($62,989). In addition, mechanical ventilation use and associated inpatient resource use varied across hospitals, with higher use observed in teaching hospitals.
CONCLUSIONS: A substantial proportion of hospitalized lung cancer patients at the end of life received invasive mechanical ventilation, which was associated with longer hospital stays and higher inpatient costs. Variation across patient and hospital characteristics suggests heterogeneity in end-of-life inpatient care practices. These findings underscore the importance of focusing on how clinical practice during terminal hospitalizations aligns with guideline-recommended approaches to end-of-life care.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD40
Topic
Health Service Delivery & Process of Care
Disease
SDC: Oncology