Population-based estimates of transbronchial lung biopsy utilization and complications
Population-based estimates of transbronchial lung biopsy utilization and complications
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DOI：
10.1016/j.rmed.2012.08.008
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发表时间：
2012-11-01
影响因子：
4.3
通讯作者：
Wiener, Renda Soylemez
中科院分区：
文献类型：
--
作者：
Tukey, Melissa H.;Wiener, Renda Soylemez
背景资料：鲜为人知的是，在利用率或并发症率的经支气管肺活检的趋势，特别是在社区hospitals.Methods：我们使用的医疗保健成本和利用项目佛罗里达州住院和国家门诊手术数据库，以评估从2000年至2009年在成人经支气管肺活检利用的趋势。我们随后计算了基于人群的经支气管肺活检相关并发症的估计值（医源性气胸和手术相关出血）并确定与并发症相关的特征。从2000年到2009年，佛罗里达每10万成年人经支气管活检的年龄调整率下降了25%，从74下降到55（p < 0.0001），尽管支气管镜检查的总体使用稳定。对82，059例手术的分析显示，在研究期间，与经支气管活检相关的并发症不常见且稳定，（95% CI 0.94-1.01%）并发气胸的手术，0.55%（95% CI 0.52-0.58%），手术相关出血为0.58%（95% CI 0.55-0.61%）。COPD患者（OR 1.51，95% CI 1.31-1.75）和女性（OR 1.32，95%CI 1.15-1.52）发生气胸的风险增加，（OR 2.85，95% CI 2.10-3.87），肝硬化（OR 2.31，95% CI 1.18-4.52），年龄较大（OR 1.17，95% CI 1.09-1.25）和女性（OR 1.40，95%CI 1.17-1.68）与较高的手术相关出血风险相关。相对于支气管镜检查的总体使用，经支气管肺活检的使用正在减少。尽管如此，它仍然是一种安全的手术，并发症的风险很低。(C)2012爱思唯尔有限公司保留所有权利。
Background: Little is known about trends in the utilization or complication rates of transbronchial lung biopsy, particularly in community hospitals.Methods: We used the Healthcare Cost and Utilization Project Florida State Inpatient and State Ambulatory Surgical Databases to assess trends in transbronchial lung biopsy utilization in adults from 2000 to 2009. We subsequently calculated population based estimates of complications associated with transbronchial lung biopsy (iatrogenic pneumothorax and procedure-related hemorrhage) and identified characteristics associated with complications.Results: From 2000 to 2009, the age-adjusted rate of transbronchial biopsies per 100,000 adults in Florida decreased by 25% from 74 to 55 (p < 0.0001), despite stability in the overall utilization of bronchoscopy. Analysis of 82,059 procedures revealed that complications associated with transbronchial biopsy were uncommon and stable over the study period, with 0.97% (95% CI 0.94-1.01%) of procedures complicated by pneumothorax, 0.55% (95% CI 0.52-0.58%) by pneumothorax requiring chest tube placement, and 0.58% (95% CI 0.55-0.61%) by procedure-related hemorrhage. Patients with COPD (OR 1.51, 95% CI 1.31-1.75) and women (OR 1.32, 95% CI 1.15-1.52) were at increased risk for pneumothorax, while renal failure (OR 2.85, 95% CI 2.10-3.87), cirrhosis (OR 2.31, 95% CI 1.18-4.52), older age (OR 1.17, 95% CI 1.09-1.25) and female sex (OR 1.40, 95% CI 1.17-1.68) were associated with higher risk of procedure-related hemorrhage.Conclusions: Utilization of transbronchial lung biopsy is decreasing relative to the overall use of bronchoscopy. Nevertheless, it remains a safe procedure with low risk of complications. (C) 2012 Elsevier Ltd. All rights reserved.