SESSION TITLE: Patient Safety Initiatives
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 29, 2014 at 07:30 AM - 08:30 AM
PURPOSE: Iatrogenic Pneumothorax (IP) is a well-known complication of pulmonary procedures including thoracentesis, bronchoscopy, lung biopsy etc. Improved localization techniques like ultrasound guidance have been used to decrease the incidence of pneumothorax. With increasing emphasis on preventing adverse events following medical procedures, it is important to study outcomes in various pulmonary complications as it relates to our practice. We therefore studied the trends, predictors and outcomes of iatrogenic pneumothorax requiring chest tubes in United States from 2000 to 2009.
METHODS: We used nationwide inpatient sample (NIS) from the years 2000 to 2009 to identify IP requiring chest tube in adults aged 18 and above using ICD 9 codes. NIS contains deidentified data from over 1000 community hospitals in United States. To exclude post operative pneumothorax, we did not include patients who had any open thoracic surgery procedures including open lung biopsy and VATS. We examined the trends of IP including those requiring chest tubes over this period. We also examined factors associated with increased risk of IP requiring chest tubes by multivariable logistic regression modeling. This model adjusted for age, gender, race, hospital characteristics - teaching, bed size, location, presence of COPD, interstitial lung disease, obesity, lung cancer, pneumonia, invasive mechanical ventilation and year.
RESULTS: There were 458,906 IP in adult patients between 2000 and 2009. When adjusted for number of admissions for a given year, the number of IP remained stable from 2000 (0.14%) to 2006 (0.14%) and then increased from 2006 to 2009 (0.16%). Of 458,906 patients with IP, 51% required chest tubes. The proportion of patients with IP requiring chest tubes did not change over time. The variables associated with increased incidence of IP requiring chest tubes were age (OR 1.02, 95%CI 1.01-1.03), teaching hospitals (OR 1.27, 95%CI 1.19-1.36), presence of lung cancer (OR 21.1, 95%CI 19.2-23.1), COPD (OR 1.76, 95%CI 1.63-1.90), interstitial lung disease (OR 1.73, 95%CI 1.54-1.94) and invasive mechanical ventilation (OR 23.9, 95%CI 21.3-26.8).
CONCLUSIONS: There is recent increase in the trends of IP. Lung cancer and Invasive mechanical ventilation are associated with highest risk for developing IP
CLINICAL IMPLICATIONS: With availability of better tools like ultrasound guided procedures the increase in trends of IP is concerning and we need to look into the indivisual factors driving this trend in more detail.
DISCLOSURE: The following authors have nothing to disclose: Shahryar Ahmad, Awani Deshmukh, Jawad Hussain, Rahul Nanchal, Amit Taneja, Gagan Kumar
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