Safety and Costs of Endobronchial Ultrasound-Guided Nodal Aspiration and Mediastinoscopy
There remains debate over the best invasive diagnostic modality for mediastinal nodal evaluation. Prior studies have limited generalizability and insufficient power to detect differences in rare adverse events. We compared the risks and costs of endobronchial ultrasound (EBUS)-guided nodal aspiratio...
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Veröffentlicht in: | Chest 2020-03, Vol.157 (3), p.686-693 |
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creator | Verdial, Francys C. Berfield, Kathleen S. Wood, Douglas E. Mulligan, Michael S. Roth, Joshua A. Francis, David O. Farjah, Farhood |
description | There remains debate over the best invasive diagnostic modality for mediastinal nodal evaluation. Prior studies have limited generalizability and insufficient power to detect differences in rare adverse events. We compared the risks and costs of endobronchial ultrasound (EBUS)-guided nodal aspiration and mediastinoscopy performed for any indication in a large national cohort.
We conducted a retrospective study (2007-2015) with MarketScan, a claims database of individuals with employer-provided insurance in the United States. Patients who underwent multimodality mediastinal evaluation (n = 1,396) or same-day pulmonary resection (n = 2,130) were excluded. Regression models were used to evaluate associations between diagnostic modalities and risks and costs while adjusting for patient characteristics, year, concomitant bronchoscopic procedures, and lung cancer diagnosis.
Among 30,570 patients, 49% underwent EBUS. Severe adverse events—pneumothorax, hemothorax, airway/vascular injuries, or death—were rare and invariant between EBUS and mediastinoscopy (0.3% vs 0.4%; P = .189). The rate of vocal cord paralysis was lower for EBUS (1.4% vs 2.2%; P < .001). EBUS was associated with a lower adjusted risk of severe adverse events (OR, 0.42; 95% CI, 0.32-0.55) and vocal cord paralysis (OR, 0.57; 95% CI, 0.54-0.60). The mean cost of EBUS was $2,211 less than mediastinoscopy ($6,816 vs $9,023; P < .001). After adjustment this difference decreased to $1,650 (95% CI, $1,525-$1,776).
When performed as isolated procedures, EBUS is associated with lower risks and costs compared with mediastinoscopy. Future studies comparing the effectiveness of EBUS vs mediastinoscopy in the community at large will help determine which procedure is superior or if trade-offs exist. |
doi_str_mv | 10.1016/j.chest.2019.09.021 |
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We conducted a retrospective study (2007-2015) with MarketScan, a claims database of individuals with employer-provided insurance in the United States. Patients who underwent multimodality mediastinal evaluation (n = 1,396) or same-day pulmonary resection (n = 2,130) were excluded. Regression models were used to evaluate associations between diagnostic modalities and risks and costs while adjusting for patient characteristics, year, concomitant bronchoscopic procedures, and lung cancer diagnosis.
Among 30,570 patients, 49% underwent EBUS. Severe adverse events—pneumothorax, hemothorax, airway/vascular injuries, or death—were rare and invariant between EBUS and mediastinoscopy (0.3% vs 0.4%; P = .189). The rate of vocal cord paralysis was lower for EBUS (1.4% vs 2.2%; P < .001). EBUS was associated with a lower adjusted risk of severe adverse events (OR, 0.42; 95% CI, 0.32-0.55) and vocal cord paralysis (OR, 0.57; 95% CI, 0.54-0.60). The mean cost of EBUS was $2,211 less than mediastinoscopy ($6,816 vs $9,023; P < .001). After adjustment this difference decreased to $1,650 (95% CI, $1,525-$1,776).
When performed as isolated procedures, EBUS is associated with lower risks and costs compared with mediastinoscopy. Future studies comparing the effectiveness of EBUS vs mediastinoscopy in the community at large will help determine which procedure is superior or if trade-offs exist.</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1016/j.chest.2019.09.021</identifier><identifier>PMID: 31605700</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Bronchoscopy - adverse effects ; Bronchoscopy - economics ; Bronchoscopy - methods ; Endoscopic Ultrasound-Guided Fine Needle Aspiration - adverse effects ; Endoscopic Ultrasound-Guided Fine Needle Aspiration - economics ; Endoscopic Ultrasound-Guided Fine Needle Aspiration - methods ; Female ; Health Care Costs - statistics & numerical data ; Health Expenditures - statistics & numerical data ; Hemothorax - epidemiology ; Hemothorax - etiology ; Humans ; Lung Neoplasms - pathology ; Lymph Nodes - pathology ; Male ; Mediastinoscopy - adverse effects ; Mediastinoscopy - economics ; Mediastinoscopy - methods ; mediastinum ; Middle Aged ; Mortality ; Neoplasm Staging ; patient safety ; Pneumothorax - epidemiology ; Pneumothorax - etiology ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Respiratory System - injuries ; Retrospective Studies ; staging ; Thoracic Oncology: Original Research ; Vascular System Injuries - epidemiology ; Vascular System Injuries - etiology ; Vocal Cord Paralysis - epidemiology ; Vocal Cord Paralysis - etiology</subject><ispartof>Chest, 2020-03, Vol.157 (3), p.686-693</ispartof><rights>2019 American College of Chest Physicians</rights><rights>Copyright © 2019 American College of Chest Physicians. All rights reserved.</rights><rights>2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. 2019 American College of Chest Physicians</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3741-8c185874e51b4cd31ed947b3d405dba50cc05a78657d5ab90e10825d19c191f93</citedby><cites>FETCH-LOGICAL-c3741-8c185874e51b4cd31ed947b3d405dba50cc05a78657d5ab90e10825d19c191f93</cites><orcidid>0000-0001-5361-1647</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,778,782,883,27907,27908</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31605700$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Verdial, Francys C.</creatorcontrib><creatorcontrib>Berfield, Kathleen S.</creatorcontrib><creatorcontrib>Wood, Douglas E.</creatorcontrib><creatorcontrib>Mulligan, Michael S.</creatorcontrib><creatorcontrib>Roth, Joshua A.</creatorcontrib><creatorcontrib>Francis, David O.</creatorcontrib><creatorcontrib>Farjah, Farhood</creatorcontrib><title>Safety and Costs of Endobronchial Ultrasound-Guided Nodal Aspiration and Mediastinoscopy</title><title>Chest</title><addtitle>Chest</addtitle><description>There remains debate over the best invasive diagnostic modality for mediastinal nodal evaluation. Prior studies have limited generalizability and insufficient power to detect differences in rare adverse events. We compared the risks and costs of endobronchial ultrasound (EBUS)-guided nodal aspiration and mediastinoscopy performed for any indication in a large national cohort.
We conducted a retrospective study (2007-2015) with MarketScan, a claims database of individuals with employer-provided insurance in the United States. Patients who underwent multimodality mediastinal evaluation (n = 1,396) or same-day pulmonary resection (n = 2,130) were excluded. Regression models were used to evaluate associations between diagnostic modalities and risks and costs while adjusting for patient characteristics, year, concomitant bronchoscopic procedures, and lung cancer diagnosis.
Among 30,570 patients, 49% underwent EBUS. Severe adverse events—pneumothorax, hemothorax, airway/vascular injuries, or death—were rare and invariant between EBUS and mediastinoscopy (0.3% vs 0.4%; P = .189). The rate of vocal cord paralysis was lower for EBUS (1.4% vs 2.2%; P < .001). EBUS was associated with a lower adjusted risk of severe adverse events (OR, 0.42; 95% CI, 0.32-0.55) and vocal cord paralysis (OR, 0.57; 95% CI, 0.54-0.60). The mean cost of EBUS was $2,211 less than mediastinoscopy ($6,816 vs $9,023; P < .001). After adjustment this difference decreased to $1,650 (95% CI, $1,525-$1,776).
When performed as isolated procedures, EBUS is associated with lower risks and costs compared with mediastinoscopy. Future studies comparing the effectiveness of EBUS vs mediastinoscopy in the community at large will help determine which procedure is superior or if trade-offs exist.</description><subject>Bronchoscopy - adverse effects</subject><subject>Bronchoscopy - economics</subject><subject>Bronchoscopy - methods</subject><subject>Endoscopic Ultrasound-Guided Fine Needle Aspiration - adverse effects</subject><subject>Endoscopic Ultrasound-Guided Fine Needle Aspiration - economics</subject><subject>Endoscopic Ultrasound-Guided Fine Needle Aspiration - methods</subject><subject>Female</subject><subject>Health Care Costs - statistics & numerical data</subject><subject>Health Expenditures - statistics & numerical data</subject><subject>Hemothorax - epidemiology</subject><subject>Hemothorax - etiology</subject><subject>Humans</subject><subject>Lung Neoplasms - pathology</subject><subject>Lymph Nodes - pathology</subject><subject>Male</subject><subject>Mediastinoscopy - adverse effects</subject><subject>Mediastinoscopy - economics</subject><subject>Mediastinoscopy - methods</subject><subject>mediastinum</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neoplasm Staging</subject><subject>patient safety</subject><subject>Pneumothorax - epidemiology</subject><subject>Pneumothorax - etiology</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Respiratory System - injuries</subject><subject>Retrospective Studies</subject><subject>staging</subject><subject>Thoracic Oncology: Original Research</subject><subject>Vascular System Injuries - epidemiology</subject><subject>Vascular System Injuries - etiology</subject><subject>Vocal Cord Paralysis - epidemiology</subject><subject>Vocal Cord Paralysis - etiology</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UcFq3DAQFaWl2Sb9gkLxsRdvZyzLtg4thCVNC2lyaAO5CVkad7V4pa1kB_bvo82mob0UBoaR3nszvMfYO4QlAjYfN0uzpjQtK0C5hFwVvmALlBxLLmr-ki0AsCp5I6sT9ialDeQZZfOanXBsQLQAC3b3Qw807QvtbbEKaUpFGIoLb0Mfgzdrp8fidpyiTmH2trycnSVbXAeb38_TzkU9ueAf2d_JOp0m50MyYbc_Y68GPSZ6-9RP2e2Xi5-rr-XVzeW31flVaXhbY9kZ7ETX1iSwr43lSFbWbc9tDcL2WoAxIHTbNaK1QvcSCKGrhEVpUOIg-Sn7fNTdzf2WrCGfrx3VLrqtjnsVtFP__ni3Vr_CvWobkFIcBD48CcTwe86Gqq1LhsZRewpzUhUHAbzmNWQoP0JNDClFGp7XIKhDJmqjHjNRh0wU5Kows97_feEz508IGfDpCKDs072jqJJx5E02NJKZlA3uvwseAFkon5c</recordid><startdate>20200301</startdate><enddate>20200301</enddate><creator>Verdial, Francys C.</creator><creator>Berfield, Kathleen S.</creator><creator>Wood, Douglas E.</creator><creator>Mulligan, Michael S.</creator><creator>Roth, Joshua A.</creator><creator>Francis, David O.</creator><creator>Farjah, Farhood</creator><general>Elsevier Inc</general><general>American College of Chest Physicians</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5361-1647</orcidid></search><sort><creationdate>20200301</creationdate><title>Safety and Costs of Endobronchial Ultrasound-Guided Nodal Aspiration and Mediastinoscopy</title><author>Verdial, Francys C. ; Berfield, Kathleen S. ; Wood, Douglas E. ; Mulligan, Michael S. ; Roth, Joshua A. ; Francis, David O. ; Farjah, Farhood</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3741-8c185874e51b4cd31ed947b3d405dba50cc05a78657d5ab90e10825d19c191f93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Bronchoscopy - adverse effects</topic><topic>Bronchoscopy - economics</topic><topic>Bronchoscopy - methods</topic><topic>Endoscopic Ultrasound-Guided Fine Needle Aspiration - adverse effects</topic><topic>Endoscopic Ultrasound-Guided Fine Needle Aspiration - economics</topic><topic>Endoscopic Ultrasound-Guided Fine Needle Aspiration - methods</topic><topic>Female</topic><topic>Health Care Costs - statistics & numerical data</topic><topic>Health Expenditures - statistics & numerical data</topic><topic>Hemothorax - epidemiology</topic><topic>Hemothorax - etiology</topic><topic>Humans</topic><topic>Lung Neoplasms - pathology</topic><topic>Lymph Nodes - pathology</topic><topic>Male</topic><topic>Mediastinoscopy - adverse effects</topic><topic>Mediastinoscopy - economics</topic><topic>Mediastinoscopy - methods</topic><topic>mediastinum</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Neoplasm Staging</topic><topic>patient safety</topic><topic>Pneumothorax - epidemiology</topic><topic>Pneumothorax - etiology</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Respiratory System - injuries</topic><topic>Retrospective Studies</topic><topic>staging</topic><topic>Thoracic Oncology: Original Research</topic><topic>Vascular System Injuries - epidemiology</topic><topic>Vascular System Injuries - etiology</topic><topic>Vocal Cord Paralysis - epidemiology</topic><topic>Vocal Cord Paralysis - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Verdial, Francys C.</creatorcontrib><creatorcontrib>Berfield, Kathleen S.</creatorcontrib><creatorcontrib>Wood, Douglas E.</creatorcontrib><creatorcontrib>Mulligan, Michael S.</creatorcontrib><creatorcontrib>Roth, Joshua A.</creatorcontrib><creatorcontrib>Francis, David O.</creatorcontrib><creatorcontrib>Farjah, Farhood</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Verdial, Francys C.</au><au>Berfield, Kathleen S.</au><au>Wood, Douglas E.</au><au>Mulligan, Michael S.</au><au>Roth, Joshua A.</au><au>Francis, David O.</au><au>Farjah, Farhood</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and Costs of Endobronchial Ultrasound-Guided Nodal Aspiration and Mediastinoscopy</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>2020-03-01</date><risdate>2020</risdate><volume>157</volume><issue>3</issue><spage>686</spage><epage>693</epage><pages>686-693</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><abstract>There remains debate over the best invasive diagnostic modality for mediastinal nodal evaluation. Prior studies have limited generalizability and insufficient power to detect differences in rare adverse events. We compared the risks and costs of endobronchial ultrasound (EBUS)-guided nodal aspiration and mediastinoscopy performed for any indication in a large national cohort.
We conducted a retrospective study (2007-2015) with MarketScan, a claims database of individuals with employer-provided insurance in the United States. Patients who underwent multimodality mediastinal evaluation (n = 1,396) or same-day pulmonary resection (n = 2,130) were excluded. Regression models were used to evaluate associations between diagnostic modalities and risks and costs while adjusting for patient characteristics, year, concomitant bronchoscopic procedures, and lung cancer diagnosis.
Among 30,570 patients, 49% underwent EBUS. Severe adverse events—pneumothorax, hemothorax, airway/vascular injuries, or death—were rare and invariant between EBUS and mediastinoscopy (0.3% vs 0.4%; P = .189). The rate of vocal cord paralysis was lower for EBUS (1.4% vs 2.2%; P < .001). EBUS was associated with a lower adjusted risk of severe adverse events (OR, 0.42; 95% CI, 0.32-0.55) and vocal cord paralysis (OR, 0.57; 95% CI, 0.54-0.60). The mean cost of EBUS was $2,211 less than mediastinoscopy ($6,816 vs $9,023; P < .001). After adjustment this difference decreased to $1,650 (95% CI, $1,525-$1,776).
When performed as isolated procedures, EBUS is associated with lower risks and costs compared with mediastinoscopy. Future studies comparing the effectiveness of EBUS vs mediastinoscopy in the community at large will help determine which procedure is superior or if trade-offs exist.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31605700</pmid><doi>10.1016/j.chest.2019.09.021</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-5361-1647</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Bronchoscopy - adverse effects Bronchoscopy - economics Bronchoscopy - methods Endoscopic Ultrasound-Guided Fine Needle Aspiration - adverse effects Endoscopic Ultrasound-Guided Fine Needle Aspiration - economics Endoscopic Ultrasound-Guided Fine Needle Aspiration - methods Female Health Care Costs - statistics & numerical data Health Expenditures - statistics & numerical data Hemothorax - epidemiology Hemothorax - etiology Humans Lung Neoplasms - pathology Lymph Nodes - pathology Male Mediastinoscopy - adverse effects Mediastinoscopy - economics Mediastinoscopy - methods mediastinum Middle Aged Mortality Neoplasm Staging patient safety Pneumothorax - epidemiology Pneumothorax - etiology Postoperative Complications - epidemiology Postoperative Complications - etiology Respiratory System - injuries Retrospective Studies staging Thoracic Oncology: Original Research Vascular System Injuries - epidemiology Vascular System Injuries - etiology Vocal Cord Paralysis - epidemiology Vocal Cord Paralysis - etiology |
title | Safety and Costs of Endobronchial Ultrasound-Guided Nodal Aspiration and Mediastinoscopy |
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