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Original Research: Pulmonary Procedures |

Complications, Consequences, and Practice Patterns of Endobronchial Ultrasound-Guided Transbronchial Needle AspirationComplications and Consequences of EBUS-TBNA: Results of the AQuIRE Registry

George A. Eapen, MD, FCCP; Archan M. Shah, MD; Xiudong Lei, PhD; Carlos A. Jimenez, MD, FCCP; Rodolfo C. Morice, MD, FCCP; Lonny Yarmus, DO, FCCP; Joshua Filner, MD; Cynthia Ray, MD; Gaetane Michaud, MD, FCCP; Sara R. Greenhill, MD, FCCP; Mona Sarkiss, MD, PhD; Roberto Casal, MD; David Rice, MD; David E. Ost, MD, FCCP on behalf of the American College of Chest Physicians Quality Improvement Registry, Education, and Evaluation (AQuIRE) Participants
Author and Funding Information

From the University of Texas MD Anderson Cancer Center (Drs Eapen, Lei, Jimenez, Morice, Sarkiss, Rice, and Ost), Houston, TX; Kaiser Permanente South Sacramento (Dr Shah), Sacramento, CA; Johns Hopkins Hospital (Dr Yarmus), Baltimore, MD; Kaiser Permanente Sunnyside Medical Center (Dr Filner), Clackamas, OR; Henry Ford Hospital (Dr Ray), Detroit, MI; Yale School of Medicine (Dr Michaud), New Haven, CT; Chicago Chest Center (Dr Greenhill), Elk Grove, IL; and Baylor College of Medicine (Dr Casal), Houston, TX.

Correspondence to: George A. Eapen, MD, FCCP, Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Unit 1462, 1515 Holcombe Blvd, Houston, TX 77030; e-mail: geapen@mdanderson.org


Funding/Support: This research was supported in part by the National Institutes of Health through a Cancer Center Support Grant [CA016672] to The University of Texas MD Anderson Cancer Center. The AQuIRE database is funded by the American College of Chest Physicians.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(4):1044-1053. doi:10.1378/chest.12-0350
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Background:  Few studies of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) have been large enough to identify risk factors for complications. The primary objective of this study was to quantify the incidence of and risk factors for complications in patients undergoing EBUS-TBNA.

Methods:  Data on prospectively enrolled patients undergoing EBUS-TBNA in the American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education (AQuIRE) database were extracted and analyzed for the incidence, consequences, and predictors of complications.

Results:  We enrolled 1,317 patients at six hospitals. Complications occurred in 19 patients (1.44%; 95% CI, 0.87%-2.24%). Transbronchial lung biopsy (TBBx) was the only risk factor for complications, which occurred in 3.21% of patients who underwent the procedure and in 1.15% of those who did not (OR, 2.85; 95% CI, 1.07-7.59; P = .04). Pneumothorax occurred in seven patients (0.53%; 95% CI, 0.21%-1.09%). Escalations in level of care occurred in 14 patients (1.06%; 95% CI, 0.58%-1.78%); its risk factors were age > 70 years (OR, 4.06; 95% CI, 1.36-12.12; P = .012), inpatient status (OR, 4.93; 95% CI, 1.30-18.74; P = .019), and undergoing deep sedation or general anesthesia (OR, 4.68; 95% CI, 1.02-21.61; P = .048). TBBx was performed in only 12.6% of patients when rapid onsite cytologic evaluation (ROSE) was used and in 19.1% when it was not used (P = .006). Interhospital variation in TBBx use when ROSE was used was significant (P < .001).

Conclusions:  TBBx was the only risk factor for complications during EBUS-TBNA procedures. ROSE significantly reduced the use of TBBx.


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