Safety of the Transbronchial Biopsy in Outpatients*

Blasco, Luis; Hernández, Ignacio M. Sánchez; Garrido, Victoria Villena; Poch, Eduardo de Miguel; Delgado, Manuel Núñez; Abreu, J. Alfaro

doi:10.1378/chest.99.3.562

Cited by 74 publications

(26 citation statements)

References 23 publications

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“…The incidence of pneumothorax when TBBxs were performed in addition to EBUS-TBNA was 2.7%, which is similar to previous reports. 13, [26][27][28][29][30][31][32] However, in contrast to previous investigations, 33,34 we found that the use of positive pressure ventilation in patients undergoing TBBx was not associated with increased pneumothorax risk. This contrast likely refl ects differences in patient populations; previous studies included patients receiving positive pressure ventilation for respiratory failure, whereas patients in this study received positive pressure ventilation only for the procedure.…”

Section: Hospital Variabilitycontrasting

confidence: 79%

Complications, Consequences, and Practice Patterns of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Eapen

Shah

Lei

et al. 2013

Chest

285

232

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Mediastinal lymph node sampling is a critical step in the staging of lung cancer [1][2][3] and in the diagnosis of infl ammatory conditions, such as sarcoidosis. [4][5][6][7][8] Over the past decade, endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive, highly accurate technique for sampling intrathoracic lymph nodes, with a sensitivity of 88% to 93% in distinguishing lymph node metastases from benign conditions. 9,10 Comparative studies have demonstrated the superiority of EBUS-TBNA to conventional TBNA. 11 EBUS-TBNA can reach multiple nodal stations, including Background: Few studies of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) have been large enough to identify risk factors for complications. The primary objective of this study was to quantify the incidence of and risk factors for complications in patients undergoing EBUS-TBNA. Methods: Data on prospectively enrolled patients undergoing EBUS-TBNA in the American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education (AQuIRE) database were extracted and analyzed for the incidence, consequences, and predictors of complications. Results: We enrolled 1,317 patients at six hospitals. Complications occurred in 19 patients (1.44%; 95% CI, 0.87%-2.24%). Transbronchial lung biopsy (TBBx) was the only risk factor for complications, which occurred in 3.21% of patients who underwent the procedure and in 1.15% of those who did not (OR, 2.85; 95% CI, 1.07-7.59; P 5 .04). Pneumothorax occurred in seven patients (0.53%; 95% CI, 0.21%-1.09%). Escalations in level of care occurred in 14 patients (1.06%; 95% CI, 0.58%-1.78%); its risk factors were age . 70 years (OR, 4.06; 95% CI, 1.36-12.12; P 5 .012), inpatient status (OR, 4.93; 95% CI, 1.30-18.74; P 5 .019), and undergoing deep sedation or general anesthesia (OR, 4.68; 95% CI, 1.02-21.61; P 5 .048). TBBx was performed in only 12.6% of patients when rapid onsite cytologic evaluation (ROSE ) was used and in 19.1% when it was not used ( P 5 .006). Interhospital variation in TBBx use when ROSE was used was signifi cant ( P , .001). Conclusions: TBBx was the only risk factor for complications during EBUS-TBNA procedures. ROSE signifi cantly reduced the use of TBBx.

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Section: Hospital Variabilitycontrasting

confidence: 79%

Complications, Consequences, and Practice Patterns of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Eapen

Shah

Lei

et al. 2013

Chest

285

232

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“…Routine monitoring of vital signs, judicious delivery of intravenous sedation and technological advances together make this procedure remarkably safe for patients in both the hospital and ambulatory setting [1, 2, 3, 4]. Procedure-related complications occur infrequently, even in ill patients such as head injury victims, patients with recent acute myocardial infarction or the elderly [5, 6, 7, 8].…”

Section: Introductionmentioning

confidence: 99%

Hospital Charges Attributable to Bronchoscopy-Related Complications in Outpatients

Colt¹,

Matsuo²

2001

Respiration

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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.

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“…In the study done by Prakash et al, [12] transbronchial lung biopsy was done with the aid of fluoroscopy with a diagnostic yield of 75.9% and complications (pneumothorax) were observed in 1.26% patients. Transbronchial lung biopsy can be performed safely and effectively on out-patient basis in selected cases as done by Suri et al and Hernández Blasco et al [13,14] (15) 26 76% R.K.Ailani (16) 30 77% Andersen (17) 939 79.4% Milman et al (18) 126 66.7% Mitchell et al (19) 183 61% Szlubowski et al (20) 123 65% Ibrahim AS et al (21) 71 81.7% Ahluwalia et al (22) 25 80% Present study 20 70% …”

Section: Discussionmentioning

confidence: 99%

Role of Trans Bron Chial Lung Biopsy in Diffuse Parenchymal Lung Diseases

Narender¹,

Koppu²,

Rao³

et al. 2015

jemds

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Diffuse parenchyma lung disease (DPLD) encompasses a hetero-geneous group of disorders, characterized by a spectrum of inflammatory and fibrotic changes affecting alveolar walls and air spaces. They comprise over 200 entities and include a wide spectrum of diseases, many uncommon and many of unknown etiology. The incidence and prevalence rates of DPLD have not been precisely estimated due to difficulties in ascertaining a specific diagnosis on a specific disease.

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Safety of the Transbronchial Biopsy in Outpatients*

Cited by 74 publications

References 23 publications

Complications, Consequences, and Practice Patterns of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Complications, Consequences, and Practice Patterns of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Hospital Charges Attributable to Bronchoscopy-Related Complications in Outpatients

Role of Trans Bron Chial Lung Biopsy in Diffuse Parenchymal Lung Diseases

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