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
Hauptverfasser: Verdial, Francys C., Berfield, Kathleen S., Wood, Douglas E., Mulligan, Michael S., Roth, Joshua A., Francis, David O., Farjah, Farhood
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container_end_page 693
container_issue 3
container_start_page 686
container_title Chest
container_volume 157
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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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 &lt; .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 &lt; .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. 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The rate of vocal cord paralysis was lower for EBUS (1.4% vs 2.2%; P &lt; .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 &lt; .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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