Study objective: To examine the frequency of
bronchoscopy performance in a large tertiary medical center over a
period of 8 years.
Design: Retrospective data
Setting: Academic medical center.
Materials and methods: Using a computerized database of all
bronchoscopies performed between 1991 and 1997, we analyzed trends in
(1) the total number of bronchoscopies; and (2) the numbers of
bronchoscopies performed for patients on the basis of the
postbronchoscopic diagnosis in the following three main disease groups:
AIDS, interstitial lung disease (ILD), and lung cancer. We
measured the following outcomes in the patients of high-volume and
low-volume bronchoscopists: procedure length (time to perform
procedure), nondiagnostic rate, and repeat-bronchoscopy rate. In
addition, we compared total admissions, outpatient visits, and
insurance status of the patients during the same period.
Results: In total, 5,580 bronchoscopies were
performed. A 17% decline in the number of procedures was noted between
1991 and 1997 (from 943 to 783, respectively; p < 0.05). The
number of AIDS-related bronchoscopies fell from 235 (25% of 943) to 96
(12% of 783), a 59% decline during this period (p < 0.05).
There was a corresponding 76% decrease in the number of bronchoscopies
associated with a diagnosis of Pneumocystis carinii
pneumonia (PCP; p < 0.05). During the same period, no similar
decrease was noted in the number of bronchoscopies associated with a
diagnosis of ILD or lung cancer. Moreover, no significant differences
were noted in the procedure length, nondiagnostic rate, or
repeat-bronchoscopy rate between high-volume and low-volume
bronchoscopists. Although there was no significant change in the number
of total admissions between 1991 and 1997, there was a 48% increase in
the number of managed-care patients and a 25.4% increase in the number
of Medicaid health insurance program for California patients
between 1991 and 1997.
Conclusions: We noted a
significant decline in the number of bronchoscopies performed between
1991 and 1997. The significant reduction in the number of
AIDS-associated bronchoscopies accounted for 87% of the
decline. Other possible factors include the introduction of a
management pathway for the empiric treatment of PCP in 1996, a
reduction in the number of pulmonary admissions, an increase in the
number of managed care patients, and a reduction in the remuneration
for the performance of bronchoscopy.