Surgical lung biopsy for interstitial lung disease is a safe procedure in carefully selected patients.

Purpose: Surgical lung biopsy (SLB) offers the highest histopathologic yield for interstitial lung disease (ILD). We sought to identify risk factors for complications, and developed a predictive model to help stratify risk for patients being considered for SLB.

Methods: Large single center retrospective study of outpatient SLBs with individually confirmed biopsy indication. Demographics, pulmonary function, and echocardiogram reports were analyzed for association with complications, measured by length of stay (LOS). A LOS ≥7 days (including readmissions) in the first 90 post procedure days was taken to represent serious complications. Logistic regression was used to determine who could safely undergo SLB, defined as a LOS ≤2 days.

Results: 172 of 231 (75 %) patients had a LOS ≤2 days. Serious complications occurred in 13 (5.6 %), including 6 (2.6 %) exacerbations and 5 (2.2 %) deaths. Forced vital capacity (FVC)% was independently associated with LOS (OR of 0.98, 95 % CI 0.97-0.99). Right ventricular systolic pressure (RVSP) was also independently associated with LOS >2 days (OR 1.51, 95 % CI 1.09, 2.14).

Interpretation: In our experience SLB remains an important tool in the management of patients with ILD. Risk stratification suggests that patients with lower FVC% and pulmonary hypertension are at higher risk for increased LOS and a more complicated post-procedure recovery. The odds of complications increase by 51 % with each 1 mm Hg increase in RVSP as assessed by echocardiography. Risk might be mitigated by referring patients for SLB earlier, rather than reserving it for when more severe disease has developed.