Invasive Procedures and Associated Complications After Initial Lung Cancer Screening in a National Cohort of Veterans

Abstract

Little is known about rates of invasive procedures and associated complications after lung cancer screening (LCS) in nontrial settings. What are the frequency of invasive procedures, complication rates, and factors associated with complications in a national sample of veterans screened for lung cancer? We conducted a retrospective cohort analysis of veterans who underwent LCS in any Veterans Health Administration (VA) facility between 2013 and 2019 and identified veterans who underwent invasive procedures within 10months of initial LCS. The primary outcome was presence of a complication within 10days after an invasive procedure. We conducted hierarchical mixed-effects logistic regression analyses to determine patient- and facility-level factors associated with complications resulting from an invasive procedure. Our cohort of 82,641 veterans who underwent LCS was older, more racially diverse, and had more comorbidities than National Lung Screening Trial (NLST) participants. Overall, 1,741 veterans (2.1%) underwent an invasive procedure after initial screening, including 856 (42.3%) bronchoscopies, 490 (24.2%) transthoracic needle biopsies, and 423 (20.9%) thoracic surgeries. Among veterans who underwent procedures, 151 (8.7%) experienced a major complication (eg, respiratory failure, prolonged hospitalization) and an additional 203 (11.7%) experienced an intermediate complication (eg, pneumothorax, pleural effusion). Veterans who underwent thoracic surgery (OR, 7.70; 95%CI, 5.48-10.81), underwent multiple nonsurgical procedures (OR, 1.49; 95%CI, 1.15-1.92), or carried a dementia diagnosis (OR, 3.91; 95%CI, 1.79-8.52) were more likely to experience complications. Invasive procedures were performed less often than in the NLST (2.1%vs4.2%), but veterans were more likely to experience complications after each type of procedure. These findings may reflect a higher threshold to perform procedures in veteran populations with multiple comorbidities and higher risks of complications. Future work should focus on optimizing the identification of patients whose chance of benefit likely outweighs the complication risks.