Inpatient complication rates of bronchoscopic lung volume reduction in the United States.

Abstract

Early randomized controlled trials (RCTs) of bronchoscopic lung volume reduction (BLVR) have shown clinically meaningful benefits in lung function, dyspnea, and quality of life in patients with severe emphysema. Safety outcome data following BLVR in the US are scarce outside the RCTs. What is the rate of inpatient complications after BLVR in the real world in the US? We used The National In-patient Sample (NIS) database to identify in-hospital complications post-BLVR from 2018 to 2020. Complications were defined as pneumothorax, COPD exacerbation, pneumonia, hemoptysis, acute respiratory failure, and valve removal. We also analyzed all-cause in-hospital mortality and length of stay (LOS). We identified 467 admissions related to BLVR procedures. The number of procedures doubled between 2019 and 2020 (from 153 to 295 procedures). The median age was 67.9 years (IQR 61.1 - 72.8), 210 (45.0%) were female, 401 (85.8%) were white, and Medicare was the primary expected payer in 72.8% of cases. Most procedures were done in urban teaching hospitals (56.9%). The rate of pneumothorax was 26.3%, acute respiratory failure 19.5%, COPD exacerbation 8.8%, pneumonia 7.3%, and hemoptysis 5.3%. Chest tube placement was required in 84 out of 123 (68.3%) cases of pneumothorax. The endobronchial valve had to be removed in 69 cases (14.8%). The median LOS was 2.8 days (IQR 2.3 -4.5). The number of in-hospital deaths was less than 11 cases (< 2.3%). Overall, the subgroup who had in-hospital complications did not differ significantly from the others in terms comorbidities, demographics, and hospital characteristics. The real-world complication rate after BLVR was similar to the published complication rates from early randomized clinical trials. In-hospital mortality was low, suggesting that aside from the commonly anticipated complications, BLVR is a safe treatment option for severe emphysema.