Endobronchial valves for persistent air leak all-cause mortality and financial impact: US trend from 2012–2016

Abstract

Background: Endobronchial valves (EBV) are considered an innovation in the management of the persistent air leak (PAL). They offer a minimally invasive alternative to the traditional approach of pleurodesis and surgical intervention. We examined trends in mortality, length of stay (LOS), and resources utilization in patients who underwent EBV placement for PAL in the US. Methods: We utilized discharge data from the Nationwide Inpatient Sample (NIS) for five years (2012-2016). We included adults diagnosed with a pneumothorax who underwent EBV insertion at ≥ 3 days from the day of chest tube placement; or following invasive thoracic procedure. We analyzed all-cause mortality, LOS, and resources utilization in the study population. Results: A total of 1,885 cases met our inclusion criteria. Patients were mostly middle-aged, males, whites, and had significant comorbidities. The average LOS was 21.8 ± 20.5 days, the mean time for chest tube placement was 3.8 ± 5.9 days, and the mean time for EBV insertion was 10.5 ± 10.3 days. Pleurodesis was performed before and after EBV placement and in 9% and 6%, respectively. Conclusions: Our study showed that the all-cause mortality rate fluctuated throughout the years at around 10%. Despite EBV being a minimally invasive alternative, its use has not trended up significantly during the study period. EBVs are also being used off-label in the US for spontaneous pneumothorax. This study shall provide more data to the scarce literature about EBV for PAL.

Perioperative management and surgical procedure for prolonged air leak: a clinical practice review

“…There are several case series reports describing the success of endoscopic therapy for Watanabe spigots (16,17) and one-way valves placement (18)(19)(20). Both techniques are minimally invasive treatments that involve the insertion of a plug into the bronchus and are expected to be an alternative to surgery.…”

“…Both techniques are minimally invasive treatments that involve the insertion of a plug into the bronchus and are expected to be an alternative to surgery. Especially in recent years, the usefulness of implanting a one-way endobronchial valve has been widely reported (20). In both procedures, care must be taken to avoid infection and decreased lung function due to inhibition of the expansion of the remaining lung.…”