Acute Care/Hospitalization

Accidental lung puncture is a substantial threat to hospitalized patients undergoing a wide range of procedures

When a patient's lung is accidentally punctured during an invasive medical or surgical procedure, air leaks from the lung into the space surrounding the lungs (pleura), leading to partial or complete lung collapse. This accidental iatrogenic pneumothorax (AIP) is a substantial threat to hospitalized patients undergoing a wide range of procedures. Agency for Healthcare Research and Quality (AHRQ) researcher Chunliu Zhan, M.D., Ph.D., and colleagues found that patients who were admitted to the hospital for pleurisy (inflammation of the lining of the lungs), cancer of the kidney and renal pelvis, or conduction disorders and complications of cardiac devices had the highest rates of AIP during hospitalization, with AIP rates of 2.24 percent, 1.14 percent, and 0.83 percent, respectively.

The researchers identified AIP risk for specific procedures, which varied from 2.68 percent for patients who underwent thoracentesis (fluid removed from the pleural space), to 1.30 percent for those who underwent nephrectomy (surgical removal of a kidney), and 0.06 percent for those who underwent gastrostomy (surgical construction of a hole for a feeding tube).

These findings were based on analysis of 7.5 million hospital discharge abstracts from 994 short-term acute hospitals across 28 States based on 2000 data in AHRQ's Healthcare Cost and Utilization Project Nationwide Inpatient Sample. The researchers used patient safety indicators to identify AIP that might have been prevented with better care.

More details are in "Accidental iatrogenic pneumothorax in hospitalized patients," by Dr. Zhan, Maureen Smith, M.D., Ph.D., and Daniel Stryer, M.D., in the February 2006 Medical Care 44(2), pp. 182-186. Reprints (AHRQ Publication No. 06-R029) are available from The AHRQ Publication Clearinghouse.

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