Bronchoscopy Use Trends Among Patients Receiving Invasive Mechanical Ventilation

About 10% of US patients in acute respiratory failure treated with invasive mechanical ventilation (IMV) from 2012 to 2018 had a bronchoscopy, and the use of bronchoscopy with IMV has increased over time, according to research reported in CHEST.

The retrospective cohort study used data from the National Inpatient Sample (NIS), a database of the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project. The cohort included hospitalized adults (aged ≥18 years) who were treated with IMV from 2012 to 2018 per International Classification of Diseases procedural codes. The primary measure was the annual proportion of IMV hospitalizations that had an accompanying bronchoscopy.

The researchers calculated population estimates for the proportion of IMV hospitalizations with bronchoscopy with use of sampling weights from the NIS and assessed for trends over time.

Of the 6,101,070 (95% CI, 6,027,690-6,174,451) IMV-treated hospitalized patients from 2012 to 2018, 609,405 (95% CI, 596,975-621,836) or 10.0% (95% CI, 9.8-10.1) underwent a bronchoscopy. Of the hospitalized patients who received a bronchoscopy, the mean age was 61 years, 58.2% were men, 71.2% were White, and 14.2% were Black. The mean length of stay was 15 days, and 30.8% had in-hospital mortality.

The proportion of IMV hospitalizations with bronchoscopy increased from 9.5% (95% CI, 9.1-9.9) in 2012 to 10.8% (95% CI, 10.4-11.2) in 2018 (P <.001), an absolute increase of 1.3% and a relative increase of 13.7%. The total number of bronchoscopies from the IMV hospitalizations increased from 77,835 (95% CI, 72,060-83,610) to 98,745 (95% CI, 91,952-105,538).

Mortality among hospitalized patients who had a bronchoscopy increased from 29.8% to 31.8%, which was consistent with mortality for all IMV hospitalizations (30.2% to 31.2%).

Of the 1787 hospitals with at least 25 IMV hospitalizations in 2018, the proportion of IMV hospitalizations with a bronchoscopy ranged from 0% to 57.1%. In multilevel analysis that adjusted for patient and hospital characteristics, 16.0% of the variation in bronchoscopy was accounted for at the hospital level. The median odds ratio was 2.13 (95% CI, 2.05-2.21), for a 113% increased odds of receiving bronchoscopy when changing from a lower-use hospital to a higher-use hospital.

Study limitations include the use of diagnostic and procedural codes to identify the participants and outcome of interest. Also, the design of the NIS changed in 2012, precluding assessment of trends over time for any individual hospital, and the researchers were unable to assess the impact of bronchoscopy on postdischarge outcomes or patient-centered outcomes such as changes in management or the impact of providers on the use of bronchoscopy.

“In this population-based national cohort of US hospitalizations for respiratory failure, nearly 1 in 10 hospitalizations received bronchoscopy, and use increased over time,” the researchers stated. “However, use varied markedly across hospitals, and was not completely explained by differences in patient or hospital characteristics. This variation suggests potentially unwarranted practice variation and need for further studies to clarify which patients benefit from bronchoscopy.”

Reference

Wayne MT, Valley TS, Arenberg DA, De Cardenas J, Prescott HC. Temporal trends and variation in bronchoscopy use for acute respiratory failure in the US. Chest. Published online August 22, 2022. doi:10.1016/j.chest.2022.08.2210