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This Article Full Text (PDF) All Versions of this Article: chest.08-0580v1 134/3/514    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Google Scholar Articles by Ernst, A. Articles by Herth, F. J. PubMed PubMed Citation Articles by Ernst, A. Articles by Herth, F. J.

Prospective Risk- Adjusted Morbidity and Mortality Outcome Analysis after Therapeutic Bronchoscopic Procedures: Results of a Multi- Institutional Outcomes Database

Interventional Pulmonology and Thoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit Division of Pulmonary and Critical Medicine, New York University Hospital, New York Pulmonary and Critical Care Medicine, Thoraxklinik Heidelberg, Germany

aernst{at}bidmc.harvard.edu

Abstract

IntroductionInterest in databases is growing to allow for outcomes research, assess health care quality, determine best practices and resource allocation and they are increasingly considered as a tool to potentially tie reimbursement to outcome parameters. Little is known about resource use and risk adjusted morbidity and mortality after therapeutic bronchoscopic interventions.

MethodsData were extracted and reviewed from an ongoing prospective, multi-institutional outcomes database for therapeutic bronchoscopic interventions. All consecutive patients are entered into this database and information on demographics, indications, procedures and anesthesia, co- morbidities and general health status, urgency of intervention, morbidity and mortality to 30 days, increase in levels of care and procedural resources are documented.

ResultsFrom 12/2005 to 5/2007 554 therapeutic procedures were performed in 4 hospitals. Most procedures were done under general anesthesia (n=362) and rigid bronchoscopy (n=483) and the most common intervention was airway stent placement (n= 258). Forty-two percent of procedures were done urgently or emergently. Complications were common (19.8%) and 30 day mortality was 7.8%, correlating with underlying health status and urgency of intervention.

DiscussionProspective and ongoing data analysis for bronchoscopic procedures is feasible and valuable. Risk- adjusted and disease- specific outcomes can be documented and potentially used for quality assessment, bench marking and quality improvement initiatives. Appropriate use of resources and effect of interventions can be documented. Extending the number of participating centers as well as inclusion of quality of life tools and technical success are next steps.

Key Words: Bronchoscopy • Outcomes • Complications • Interventional Pulmonology