Invasive Procedures and Associated Complications Following Initial Lung Cancer Screening in a National Cohort of Veterans
Year: 2021
Type: conference-abstract
Abstract: RATIONALE: Lung cancer screening (LCS) has the potential to reduce lung cancer mortality by 20%. However, LCS clinical trials have benefitted from the 'healthy volunteer effect' and currently, little is known about rates of complications from invasive procedures in LCS in a real-world population with multiple comorbidities. Our objective was to analyze the frequency of complications from invasive procedures after undergoing screening and factors associated with development of complications. Our hypothesis is that older Veterans and those with pulmonary or cardiovascular comorbidities will be more likely to develop complications from invasive procedures. METHODS: This was a retrospective cohort analysis of Veterans who underwent LCS in any Veteran's Health Administration (VA) facility between 2013-2019. We used administrative data from VA's Corporate Data Warehouse to identify Veterans who had invasive procedures and complications. The primary outcome was presence of a complication within 10 days after an invasive procedure. We conducted hierarchical mixed effects logistic regression analyses, including both patient-and site-level variables, to determine factors associated with complications from an invasive procedure. RESULTS: Overall, we identified 84,048 Veterans that underwent LCS, of whom 2,230 (2.7%) had a subsequent invasive procedure including: 1,214 (54.5%) bronchoscopy, 620 (27.8%) transthoracic needle biopsy, and 704 (31.6%) lung surgery. Among Veterans who underwent a procedure, 416 (18.7%) had a major complication (e.g. respiratory failure, prolonged hospitalization) and an additional 315 (14.1%) experienced an intermediate complication (e.g. pneumothorax, pleural effusion). Veterans that were female (OR 0.50, 95% CI 0.29-0.86) or ages 70-74 compared to ages 65-69 (OR 0.76, 95% CI 0.60-0.97) were less likely to have a complication from an invasive procedure while Veterans that had history of stroke (OR 1.72, 95% CI 1.09-2.71), arrhythmia (OR 1.63, 95% CI 1.06-2.51) or dementia (OR 1.77, 95% CI 1.03-3.05) were more likely to have a complication. There were no differences detected among facility-level covariables or in Veterans with COPD. CONCLUSION: This is the first study to show rates of complications from invasive procedures in a national cohort of real-world patients undergoing LCS. Compared to the National Lung Screening Trial (NLST), our cohort had lower rates of invasive procedures, but higher rates of complications. These findings may reflect greater discrimination in performing procedures, but higher risk due to multiple comorbidities in the Veteran population. Future work should focus on optimizing identification of patients who would benefit from LCS while minimizing potential complications.
Authors: E.R. Nunez, T. Caverly, S. Zhang, M.E. Glickman, S.X. Qian, C. Butler, J. Boudreau, D.R. Miller, R.S. Wiener
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4252015368