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Prospective Risk-Adjusted Morbidity and Mortality Outcome Analysis After Therapeutic Bronchoscopic Procedures

Results of a Multi-institutional Outcomes Database

*From Interventional Pulmonology and Thoracic Surgery (Drs. Ernst and Goldman), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine (Dr. Simoff), Henry Ford Hospital, Detroit, MI; Division of Pulmonary and Critical Medicine (Dr. Ost), New York University Hospital, New York, NY; and Pulmonary and Critical Care Medicine (Dr. Herth), Thoraxklinik Heidelberg, Germany.

Correspondence to: Armin Ernst, MD, FCCP, Chief, Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Rd, Deaconess 201A, Boston, MA 02215; e-mail: aernst{at}bidmc.harvard.edu

Abstract

Introduction:Interest in databases is growing to allow for outcomes research, assess health-care quality, and 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.

Methods:Data 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, comorbidities and general health status, urgency of intervention, morbidity and mortality to 30 days, increase in levels of care, and procedural resources is documented.

Results:From December 2005 to May 2007, 554 therapeutic procedures were performed in four 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.

Discussion:Prospective 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, benchmarking, 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 the next steps.

Key Words: bronchoscopy • complications • interventional pulmonology • outcomes

Abbreviations: ASA, American Society of Anesthesiologists • CI, confidence interval • OR, odds ratio