Chest
Volume 143, Issue 4, April 2013, Pages 1044-1053
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Original Research
Pulmonary Procedures
Complications, Consequences, and Practice Patterns of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Results of the AQuIRE Registry

https://doi.org/10.1378/chest.12-0350Get rights and content

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 = .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 = .012), inpatient status (OR, 4.93; 95% CI, 1.30-18.74; P = .019), and undergoing deep sedation or general anesthesia (OR, 4.68; 95% CI, 1.02-21.61; P = .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 = .006). Interhospital variation in TBBx use when ROSE was used was significant (P < .001).

Conclusions

TBBx was the only risk factor for complications during EBUS-TBNA procedures. ROSE significantly reduced the use of TBBx.

Section snippets

Materials and Methods

All patients undergoing bronchoscopy with lymph node sampling by TBNA at six centers from February 13, 2009, to August 31, 2010, were entered consecutively into AQuIRE at the time of their procedure.20 Institutional review board approval was obtained at each site (e-Appendix 1). Informed consent or a waiver of consent was obtained in accordance with institutional guidelines. Data were entered through the AQuIRE Web-based interface using standardized definitions, quality control checks, and

Results

A total of 1,317 patients were enrolled by 12 physicians from six hospitals. Baseline patient characteristics are summarized in Table 1.

Discussion

To our knowledge, this is the first report of EBUS-TBNA complications and consequences from a multicenter registry. It shows that EBUS-TBNA is a reassuringly safe procedure with an overall complication rate of only 1.4% in participating centers. The complications noted were most often secondary to concurrent TBBx. Escalations in level of care resulting from these complications were more frequent in older patients, inpatients, and patients receiving deep sedation or general anesthesia. Also to

Acknowledgments

Author contributions: Dr Eapen had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Eapen: contributed as the principal investigator (PI) for this study and to project oversight and organization, data collection, and manuscript writing.

Dr Shah: contributed to the study design, data collection and auditing, and writing of the manuscript.

Dr Lei: contributed as the primary biostatistician for the project and

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    Funding/Support: This research was supported in part by the National Institutes of Health through a Cancer Center Support Grant [CA016672] to The University of Texas MD Anderson Cancer Center. The AQuIRE database is funded by the American College of Chest Physicians.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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