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Pulmonology Procedures |

Trainee Impact on Endobronchial Ultrasound Complications: An Analysis of 607 Consecutive Procedures in an Interventional Pulmonary Practice

David Stather*, MD; Paul MacEachern, MD; Alex Chee, MD; Elaine Dumoulin, MD; Alain Tremblay, MD
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Department of Medicine, University of Calgary, Calgary, AB, Canada


Chest. 2012;142(4_MeetingAbstracts):919A. doi:10.1378/chest.1355864
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Abstract

SESSION TYPE: Bronchoscopy and Interventional Procedures Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Complications during endobronchial ultrasound (EBUS) are rare and include: pneumonia, pneumothorax, mediastinitis, pericarditis, hemopneumomediastinum and lymphadenitis. Increased complication rates have been demonstrated in patients undergoing routine bronchoscopy procedures performed by novice trainees. This study aims to determine the impact of trainees during EBUS procedures on procedure time, sedation use and complications.

METHODS: A retrospective review of a quality improvement database was performed from all consecutive pulmonary procedures performed by an interventional pulmonologist (D.R.S.) at the University of Calgary, from July 1st, 2007 to April 1st, 2011.

RESULTS: 607 (55.2%) of the 1100 procedures in the study involved EBUS. A trainee was present for 512 (84.3%) of these procedures. 112 (18.5%) were inpatients. A complication occurred in 25 patients (4.10%). Significant differences were seen when a trainee was present versus when no trainee was present for procedure length [58.32 versus 37.69 minutes, difference 20.63 minutes (95% C.I. 19.07-22.19), p=0.001] and for the dose of propofol used [178.28 versus 137.11 mg, difference 41.17 mg (95% C.I. 19.81-63.38), p=0.002]. More complications were seen in the trainee group [24 (4.7%) versus 1 (1.1%), difference 3.6%, p=0.076].

CONCLUSIONS: In an academic interventional pulmonology practice utilizing the apprenticeship model for bronchoscopy education, trainee participation in EBUS procedures increases procedure time, increases the amount of sedation used and results in a trend to increased complications.

CLINICAL IMPLICATIONS: The results of this study provide further evidence regarding the negative impact that the apprenticeship model of procedural education can have on patients. Attempts to modify trainee procedural training in order to reduce the burden of procedural learning for patients are warranted.

DISCLOSURE: The following authors have nothing to disclose: David Stather, Paul MacEachern, Alex Chee, Elaine Dumoulin, Alain Tremblay

No Product/Research Disclosure Information

Department of Medicine, University of Calgary, Calgary, AB, Canada

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