Fiberoptic Bronchoscopy (FOB) is a relatively safe procedure with minimal complications. However, the need to obtain a routine post-FOB chest roentgenogram (CXR) to rule out pneumothorax remains controversial and is dependent on the bronchoscopists’ bias. Our aim is to assess the incidence of post-FOB pneumothorax in a community hospital setting without pulmonary/critical care fellowship program, where all of the FOB’s are done by experienced bronchoscopists, and determine the need for routine post-FOB CXR.
All consecutive FOB’s with post-FOB CXR done at Mount Vernon Hospital (Community Teaching Hospital without Pulmonary/Critical Care fellowship program) from November of 1999 to April of 2003 were evaluated retrospectively. FOB’s were performed by three experienced ABIM Certified pulmonologists (95% by ZC).
454 procedures with routine post-procedure CXR were done during a 42-month period. 87 procedures were done on out-patients. 371 procedures were done on in-patients. 143 were on mechanical ventilators. Of 454 total FOB, only 1 case (0.22%) resulted in iatrogenic pneumothorax which was diagnosed clinically, confirmed with CXR and required thoracotomy.CONCLUSIONS: In our series of retrospective data, the incidence of pneumothorax after FOB by experienced bronchoscopists was very low (0.22%). In order to diagnose one pneumothorax, 454 routine CXR’s were taken.
In a community hospital environment without pulmonary fellows, where all of the FOB’s are done by experienced ABIM certified subspecialists, routine CXR after FOB may not be cost-effective or even medically necessary in patients without clinical evidence of pneumothorax.
Patient Characteristics (N=454 procedures)CharacteristicsNumber(%) or Mean ± SD (range)Age69.6 ± 17.1(18 - 99)Males160(35.9%)Females247(55.4%)Inpatients371(81.7%)Outpatients87(19.2%)Patients on ventilators143(35.5%)
Z. Carrey, None.