Prs57 Association Between Transient Opioid Use and Acute Copd Exacerbation Among Older Adults With Chronic Obstructive Pulmonary Disease (Copd)

Abstract

Endobronchial ultrasound (EBUS) and mediastinoscopy involve sampling thoracic lymph nodes to diagnose and stage lung cancer. These two procedures demonstrate similar diagnostic yield, although EBUS is a less invasive and more affordable sampling method. While clinical studies discuss differences in outcomes, there is limited data about EBUS adoption over the years and its impact on mediastinoscopy utilization. The objective of this study is to assess procedure trends and rates of post-procedural pneumothorax, an important potential complication of these procedures. Methods: The analysis was conducted with the Instant Health Data platform. Patients who underwent either EBUS or mediastinoscopy between 2009-2016 were identified in Medicare SAF 5% data. Relevant patient demographics were measured, including age, region, race, sex, and Elixhauser scores. Post-procedural pneumothorax rates over 3 days and 3-month preprocedural rates of chronic obstructive pulmonary disease (COPD) were also examined. Procedures were identified by CPT codes while diagnoses were identified by ICD-9/10 diagnosis codes. Results: During 2009-2016, 7,706 patients underwent EBUS while 3,944 patients underwent mediastinoscopy. No significant demographic differences were observed between the two cohorts. EBUS grew 19.3% compounded year-over-year (YoY), while mediastinoscopy was observed to decline by -9.6%. Pneumothorax rates for EBUS and mediastinoscopy were 2.4% and 14.1%, respectively, within the post-procedure period (p,0.01). These rates were generally consistent across years. Rates of pre-procedural COPD diagnoses were not statistically significantly different: 54.7% for EBUS and 61.9% for mediastinoscopy (p=0.08). Conclusions: These results suggest a growth in the use of EBUS alongside a reduction in the use of mediastinoscopy among patients undergoing thoracic lymph node sampling for lung cancer. This trend may be explained by published clinical data, which demonstrates EBUS is an equally effective and less invasive procedure. Rates of post-procedural pneumothorax were also consistently higher among mediastinoscopy patients, which is not explained by differences in pre-procedural COPD status.