Pulmonary Procedures |

EBUS-TBNA and Choice of Sedation: A Comparison Between General and Conscious Sedation Performed in OR and OPD Settings Respectively and Cost Implications FREE TO VIEW

Amir Khan, MBBS; Carolina Carillo; Ricardo Zamel; Kasia Czarnecka; Gail Darling; Andrew Pierre; Marc De perrot; Marcello Cypel; Tom Waddell; Shaf Keshavjee; Kazuhiro Yasufuku
Author and Funding Information

Interventional Thoracic Surgery, University of Toronto Network, Toronto General Hospital, Toronto, ON, Canada

Chest. 2014;146(4_MeetingAbstracts):749A. doi:10.1378/chest.1991926
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 26, 2014 at 01:30 PM - 03:00 PM

PURPOSE: The choice of anesthesia, post procedural recovery and discharge times may contribute towards the overall efficiency of the technique, which in turn may have an impact on the total cost incurred. The aim of our study is to perform a comparison between EBUS performed with general anesthesia (GA in OR) and with conscious sedation (CS) (as outpatient-OPD) settings respectively.

METHODS: A retrospective data review of 1690 patients who underwent EBUS-TBNA for last 5 years. Of these 100 patients, 50 patients who underwent EBUS-TBNA with GA (in OR) and 50 patients with CS in the Interventional Thoracic Surgery Suite (ITSS) as OPD were matched for age and gender. The following were compared: total EBUS-TBNA procedural and OR/ITSS times, pre-assessment and post recovery times (recovery was in PACU/MDU and OPD respectively) and door to door (discharge) times, average total no. of lymph nodes/mass biopsied and final diagnosis. Data were analyzed using the Wilcoxon Rank Sum test (non-parametric) with Bonferroni correction for multiple testing. Rates of positive diagnosis were analyzed using the Fisher's exact test.

RESULTS: The average age was 63 years with 18 women and 32 men in each group. The average times were 77 vs 56 minutes (p=0.19) for pre-assessment, 101 vs 50 minutes (p<0.001) total time in OR & ITSS, 56 vs 35 minutes (p<0.001) procedural time, 131 vs 55 minutes (p<0.001) post- recovery time & 321 vs 166 minutes (p<0.001) door to door (discharge) times for OR and OPD groups respectively. Average total numbers of lymph node/mass biopsied were 2.72 vs 2.82 (p=0.69) and final diagnosis (p=0.16) respectively. No serious post-procedural complications (pneumothorax, post procedure bleeding etc) were observed. The average cost was $3485 vs $1333 (p<0.01) in OR vs OPD group respectively, a projected difference of $3.6 million.

CONCLUSIONS: Our study showed significant reductions in procedural, post-recovery and discharge times in CS compared to GA groups. No significant differences were observed in pre assessment time, lesion biopsied and final diagnosis. This may translate into cost savings when EBUS TBNA is performed as CS in OPD compared to when performed with GA in OR.

CLINICAL IMPLICATIONS: Our study shows that choice of sedation and settings may effect the efficiency of the EBUS TBNA when CS in OPD is compared to GA in OR.

DISCLOSURE: The following authors have nothing to disclose: Amir Khan, Carolina Carillo, Ricardo Zamel, Kasia Czarnecka, Gail Darling, Andrew Pierre, Marc De perrot, Marcello Cypel, Tom Waddell, Shaf Keshavjee, Kazuhiro Yasufuku

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