A Multicenter, Prospective, Advanced Diagnostic Bronchoscopy Outcomes Registry

Abstract

The expense for medical care is increasing rapidly in the United States. New diagnostic and therapeutic technologies are frequently cited as a signifi cant contributor to increasing health-care costs. New technologies are usually expensive and may be of either unproven benefi t or of unclear improved effi cacy as compared with existing conventional modalities. 1 It has therefore been proposed that devices undergo more rigorous comparative evaluation to better assess their use in order to justify reimbursement levels. 2 A good example of structured comparative effectiveness analysis exists in Great Britain, with the National Institute for Health and Clinical Excellence program. 3 This group reviews the available evidence for medical interventions, assesses the potential impact on the patients and health-care systems by calculating the price to be paid for a quality-adjusted life years, and then makes recommendations regarding coverage to the respective agency. Designing trials that enable proper comparative technology evaluation is complex and expensive and funding mechanisms at least for now are limited for this kind of important research. Also lacking are Background: Multiple new diagnostic bronchoscopic technologies are available, but little is known about their comparative performance and specifi c yield when adjusted for location of lesions, target size, and diagnosis. We present a multi-institutional prospective-outcomes database to assess diagnostic yields of advanced bronchoscopic procedures, as well as related morbidity and mortality. Methods: Data were extracted and reviewed from an ongoing, paper-based, prospective, multiinstitutional outcomes database for advanced diagnostic bronchoscopic procedures. All consecutive eligible patients are entered into this database, and information on demographics, procedure, and lesion characteristics as well as complications were documented. Descriptive statistical analyses were performed. Results: A total of 310 diagnostic procedures were performed over a 1-year period in four institutions by 15 different clinicians. The majority of the patients were white (66%), male (56%), former smokers (55%), with a mean age of 61 6 14 years. The average procedure time was 36 min, and the most common procedure was transbronchial needle aspiration (TBNA) (n 5 198). Nodal tissue was obtained in 82.3% from TBNA sampling with a mean of three passes using endobronchial ultrasound guidance with a 22-gauge needle and mostly without on-site cytology. The overall diagnostic yield for all procedures was 75%. There were few complications, and none required a change in disposition. Conclusions: Prospective and ongoing data analysis for bronchoscopic procedures is feasible and valuable. Lesion-adjusted diagnostic yields can be documented and potentially used for comparative assessment of different technologies and operators, as well as benchmarking and quality improvement initiatives. Extending the number of participating centers and web-based submission to minimize missing data components ...

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