Complications Following Transthoracic Needle Biopsy of Pulmonary Nodules: A Population-Level Retrospective Cohort Analysis
Year: 2021
Type: conference-abstract
Abstract: Rationale: Transthoracic Needle Biopsy (TTNB) is commonly used for the diagnosis of lung cancer in individuals with pulmonary nodules. Although TTNB has good diagnostic accuracy, reported rates of complications, such as pneumothorax, are high. However, our knowledge of TTNB associated complications is from small single site studies or noncontemporary population level studies using data before 2007. It is unknown if complication rates have changed over time due to an evolution in practice patterns, improvements in technology, or changes in patient selection. Our study aimed to provide recent estimates of complications of TTNB and explore risk factors associated with these complications. Methods: We conducted a retrospective cohort analysis using a large nationally representative longitudinal insurance claims dataset [Optum Clinformatics Extended Data Mart]. Adults who underwent TTNB of a pulmonary lesion in 2017 or 2018 and were continuously enrolled in the 365 days prior to the biopsy (i.e. baseline period) were identified. We examined a composite outcome of complications including pneumothorax, hemorrhage, and air embolism. Separate logistic regression models were used to estimate the association of pneumothorax or hemorrhage with the setting of care (inpatient or outpatient) and selected patient demographic and clinical characteristics (assessed in the baseline period) such as age, gender, chronic obstructive pulmonary disease (COPD), pleural effusion, current/past tobacco use, use of oral anticoagulants and antiplatelet agents, prior lung cancer screening, previous bronchoscopy within one year, and Elixhauser comorbidity index. Results: We identified 16,971 eligible patients who underwent a TTNB. Among them, 25.8% experienced a complication within 3 days of the procedure. Most common complications were pneumothorax (23.3%) and hemorrhage (3.6%); air embolism was rare (0.02%). Among patients who experienced pneumothorax, 31.9% required chest tube drainage (7.4% overall). In patients undergoing TTNB in an outpatient setting (N=12,443), 6.9% of patients were hospitalized within 7 days; 56.9% of these hospitalized patients had pneumothorax. Factors such as biopsy in an inpatient setting, diagnosis of COPD, and a prior bronchoscopy were associated with higher rates of both pneumothorax and hemorrhage. Prior lung cancer screening was associated with a higher risk of pneumothorax while prior use of oral anticoagulant or antiplatelets was associated with a higher rate of hemorrhage. [See Figure Pneumothorax frequently results in the need for hospitalization and chest tube drainage.
Authors: A. Vachani, M. Zhou, S.K. Ghosh, S. Zhang, P. Szapary, D. Gaurav, I. Kalsekar
Institutions: University of Pennsylvania, Johnson & Johnson (United States)
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4234843906