The following is a summary of the “Temporal Trends and Variation in Bronchoscopy Use for Acute Respiratory Failure in the United States,” published in the January 2023 issue of Chest by Wayne, et al.
There needs to be more national data on the use of bronchoscopy to evaluate acute respiratory failure, and the data suggest substantial variation in its application.
The National Inpatient Sample, which includes data from 97% of all hospitals in the United States, was used for this observational cohort study of adult hospitalizations treated with invasive mechanical ventilation (IMV) from 2012-2018. We tallied the number of patients hospitalized for IMV who underwent bronchoscopy and looked for trends in bronchoscopy utilization over time. Adjusting for patient and hospital characteristics, multilevel linear regression models were used to quantify variation at the hospital level.
They found 6,101,070 IMV-treated hospitalizations between 2012 and 2018, of which 609,405 had a bronchoscopy. The median age of patients who had a bronchoscopy was 61, 41.8% were female, and 30.8% of them died while in the hospital. As of 2018, 10.8% (95% CI, 10.4%-11.2%) of all hospitalizations involving IMV treatment had a bronchoscopy performed, up from 9.5% (95% CI, 9.1%-9.9%) in 2012. While bronchoscopy rates ranged from 0% to 57.1% across 1,787 hospitals in 2018, 16.0% of this variation could be attributed to differences in patient and hospital characteristics in multilevel models.
Moving from a lower-use to a higher-use hospital was associated with a 113% increase in the odds of receiving a bronchoscopy, as measured by a median OR of 2.13 (95% CI, 2.05-2.21). The percentage of hospitalizations treated with bronchoscopy has grown over time among those receiving IMV. There appears to be unnecessary variation in bronchoscopy use between hospitals, and more research is needed to determine which patients would benefit from the procedure
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