Hospital Charges Attributable to Bronchoscopy-Related Complications in Outpatients

Abstract

Background: Despite literature pertaining to algorithms of care, operating room charges and other financial management issues in medicine, there is a paucity of data pertaining to the fiscal consequences of bronchoscopic practice. Objective: To identify hospital charges directly attributable to bronchoscopy-related complications in outpatients. Methods: A prospective analysis of outpatient bronchoscopy-related complications, clinical outcomes and hospital charges resulting directly from procedure-related adverse events in 660 consecutive outpatients undergoing flexible fiberoptic bronchoscopy (FFB) during a period of 30 consecutive months at the University of California, San Diego Medical Center, was performed. Results: Altogether, 1,009 consecutive outpatient FFBs were performed on 660 patients (mean age 58 years, range16–91 years). Fifty adverse events (5% of all procedures) occurred in 44 patients. These were bronchospasm (31 cases), hemoptysis (5 cases), pneumothorax (3 cases), nausea/vomiting (3 cases), hypoxemia (2 cases), seizure (2 cases), laryngeal spasm (2 cases), chills/fever (1 case) and a vasovagal episode (1 case). Prolonged length of stay in the postprocedure recovery area on 22 occasions (2.2% of all procedures) resulted in USD 6,996 in additional hospital charges. Hospitalization was necessary in only 5 instances (0.5% of all procedures), but resulted in USD 34,500 in additional charges (range for the 5 patients, USD 2,000–11,000) that were directly attributable to a procedure-related complication. Conclusion: Hospital charges directly attributable to outpatient flexible bronchoscopy-related complications are minimal, but escalate considerably if hospitalization becomes necessary.

Trainee Impact on Procedural Complications: An Analysis of 967 Consecutive Flexible Bronchoscopy Procedures in an Interventional Pulmonology Practice

“…The complication rates in our study are consistent with previously reported complication rates [9][10][11][12][13][14][15][16] . Overall complication rates from flexible bronchoscopy have been reported from 0.5 to 11% and serious complications from 0.8 to 5%, with mortality rates from 0 to 0.17% [10][11][12][13][14][15][16] .…”

“…Overall complication rates from flexible bronchoscopy have been reported from 0.5 to 11% and serious complications from 0.8 to 5%, with mortality rates from 0 to 0.17% [10][11][12][13][14][15][16] . There were no deaths in our study.…”

“…Although it is generally considered a safe procedure, complications associated with flexible bronchoscopy include: fever, pneumonia, pneumothorax, laryngospasm, bleeding, infection, myocardial infarction, congestive heart failure, respiratory failure and even death [9][10][11][12][13][14][15][16] . Very few publications have looked at the impact of trainees on flexible bronchoscopy complications [9,16] .…”

Endobronchial Fungal Disease: An Under-Recognized Entity

“…In most patients with EBFI, bronchoscopic examination correlates with the radiographic findings. Bronchospasm, pneumothorax and bleeding are seen as complications in very small percentages (4.6, 0.4 and 0.7%, respectively) with flexible bronchoscopy [133]. In the literature, no additional risk related with EBFI was mentioned, either.…”

A Prospective Analysis of 184 Hemoptysis Cases – Diagnostic Impact of Chest X-Ray, Computed Tomography, Bronchoscopy

“…In such patients, CT scanning and fiber-optic bronchoscopy with bronchial wash, bronchoalveolar lavage fluid cytology and/or endobronchial, transbronchial biopsy play an important role [4,5,6]. It remains undetermined whether these procedures provide a cost-effective yield for the investigation of patients presenting with hemoptysis and negative chest radiograph [7, 8]. It has been suggested that the high diagnostic yield of bronchoscopy justifies its use for patients with a high risk of cancer, such as male cigarette smokers over 40 years old or for the evaluation of hemoptysis of more than 1 week’s duration [7].…”