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

• DOI: 10.1378/chest.12-0350
• Publication Date: 2013-07-27T07:53:42Z
• Authors: George A. Eapen; Archan M. Shah; Xiudong Lei; Carlos A. Jimenez; Rodolfo C. Morice; Lonny Yarmus; Joshua Filner; Cynthia Ray; Gaetane Michaud; Sara R. Greenhill; Mona Sarkiss; Roberto Casal; David Rice; David E. Ost
• Keywords: Adult; Aged, 80 and over; Lung Diseases; Male; Adolescent; Biopsy, Needle; Middle Aged; 3. Good health; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Bronchoscopy; Humans; Female; Lymph Nodes; Registries; Practice Patterns, Physicians'; Child; Ultrasonography, Interventional; Aged

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.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.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 on site 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 significant ( P , .001).TBBx was the only risk factor for complications during EBUS-TBNA procedures.ROSE significantly reduced the use of TBBx.