Hospital Volume and Mortality following Diagnostic Bronchoscopy in Lung Cancer Patients: Data from a National Inpatient Database in Japan

Abstract

Background: Recent advances in bronchoscopy utilizing endobronchial ultrasound (EBUS) as well as lung cancer therapy may have driven physicians to perform diagnostic bronchoscopy (DB) for high-risk patients. Objectives: The aim of this study was to clarify the relationship between hospital volume (HV) and outcomes of DB. Methods: We collected data on inpatients with lung cancer who underwent DB from July 2010 to March 31, 2014. The annual HV of DB was classified as “very low” (≤50 cases/year), “low” (51–100 cases/year), “high” (101–300 cases/year), or “very high” (> 300 cases/year). The primary outcome was all-cause 7-day mortality after DB. Multivariable logistic regression fitted with a generalized estimation equation was performed to evaluate the association between HV and all-cause 7-day mortality after DB, adjusted for patient background factors. Results: We identified a total of 77,755 eligible patients in 954 hospitals. All-cause 7-day mortality was 0.5%. Compared with the low-volume group, 7-day mortality was significantly lower in the high-volume group (odds ratio [OR] = 0.69, 95% confidence interval [CI]: 0.52–0.92, p = 0.010), and a similar trend was shown in the very-high-volume group (OR = 0.67; 95% CI: 0.43–1.05, p = 0.080). Radial EBUS with the guide sheath method and EBUS-guided transbronchial needle aspiration showed a significantly lower 7-day mortality. Conclusions: All-cause 7-day mortality was inversely associated with HV. The risk of DB in patients with lung cancer should be recognized, and the exploitation of EBUS may help reduce mortality after DB.

Papel da broncologia no cancro do pulmão: (R)evolução nos últimos 20 anos

“…Em 2013, 89% das instituições nos EUA possuíam EBUS-TBNA sendo o número de procedimentos mais elevado naquelas com especialistas com treino em PI 7 . Em doentes submetidos a EBUS-TBNA por cancro do pulmão os registos multicêntricos demonstram rentabilidade e segurança máximas em centros com elevado número de casos, sugerindo que este exame deve ser realizado em locais com experiência 8,9 . A sensibilidade na deteção de metastização ganglionar cifra-se em 94% quando utilizado em conjugação com a mediastinoscopia 10 .…”