Respiratory malignancies among patients hospitalized with acute respiratory failure: Nationwide trends in complications, resource utilization, and outcomes.

e20085 Background: Acute respiratory failure (ARF) is a common cause of hospitalization among patients with lung cancer. Prior nationwide analyses have evaluated ARF as a complication in patients admitted to the hospital with lung cancer as the primary diagnosis, providing insight into predictors and outcomes of respiratory decompensation within cancer-indexed cohorts. In contrast, less is known about the impact of underlying respiratory malignancies on complications, resource utilization, and outcomes in patients hospitalized with ARF. Oncology patients hospitalized with ARF may represent a clinically distinct subgroup with unique complications and outcomes. Methods: The National Inpatient Sample (NIS) database from 2016-2022 was used to identify hospitalizations with ARF (ICD-10 J96.x). Patient demographics, hospital characteristics, complications, and outcomes were extracted. Respiratory malignancies included primary lung cancer, pleural malignancies, mesothelioma, and secondary lung cancers. Survey-weighted analyses compared baseline characteristics and complications by cancer status. Multivariable regression models assessed the association between respiratory cancer and in-hospital mortality, palliative care utilization, length of stay (LOS), and hospital charges. Results: A total of 3,773,741 ARF hospitalizations were identified (mean age 64.6 years, 50.7% female), of which 4.44% had an underlying respiratory malignancy. Compared with those without cancer, ARF patients with respiratory malignancy were more likely to be male, White, and treated at teaching hospitals (all p<0.001). Respiratory malignancy was associated with higher rates of pulmonary complications, including any respiratory pathology (5.17% vs 2.49%), pleural disease (17.54% vs 3.28%), pneumonitis (7.10% vs 4.33%), pneumothorax (11.50% vs 4.35%), and COPD (5.67% vs 3.69%) (all p<0.001). Infectious complications were also more frequent, including TB pneumonia (6.25% vs 4.44%), non-TB pneumonia (5.15% vs 3.99%), and sepsis (4.90% vs 4.31%) (all p<0.001). On multivariable regression analysis, respiratory malignancy was associated with higher in-hospital mortality (OR 1.56, 95% CI 1.53–1.59), greater palliative care utilization (OR 3.93, 95% CI 3.88–3.99), longer LOS (β 0.17 days, 95% CI 0.13–0.21), and lower hospital charges (β −$2,445, 95% CI −$3,159 to −$1,731) (all p<0.001). Conclusions: Among patients hospitalized with ARF, the presence of a respiratory malignancy identifies a high-risk subgroup characterized by increased respiratory and infectious complications, increased in-hospital mortality, greater palliative care utilization, and modest differences in resource utilization. These national data demonstrate the prognostic relevance of respiratory malignancy in ARF hospitalizations.