Simple Summary This study confirmed the overall safety of endosonography and guided bronchoscopy, even in a cohort of patients with multiple comorbidities and a high prevalence of advanced cancer. However, it suggested that implementing a 30-day follow-up in routine clinical practice would also help identify and treat clinically relevant late complications promptly while establishing a more realistic rate of adverse events for these procedures.Abstract Background and objective: Limited data exist regarding the adverse events of advanced diagnostic bronchoscopy, with most of the available information derived from retrospective datasets that primarily focus on early complications. Methods: We conducted a 15-month prospective cohort study among consecutive patients undergoing endosonography and/or guided bronchoscopy under general anesthesia. We evaluated the 30-day incidence of severe complications, any complication, unplanned hospital encounters, and deaths. Additionally, we analyzed the time of onset (immediate, within 1 h of the procedure; early, 1 h-24 h; late, 24 h-30 days) and identified risk factors associated with these events. Results: Thirty-day data were available for 697 out of 701 (99.4%) enrolled patients, with 85.6% having suspected malignancy and multiple comorbidities (median Charlson Comorbidity Index (IQR): 4 (2-5)). Severe complications occurred in only 17 (2.4%) patients, but among them, 10 (58.8%) had unplanned hospital encounters and 2 (11.7%) died within 30 days. A significant proportion of procedure-related severe complications (8/17, 47.1%); unplanned hospital encounters (8/11, 72.7%); and the two deaths occurred days or weeks after the procedure. Low-dose attenuation in the biopsy site on computed tomography was independently associated with any complication (OR: 1.87; 95% CI 1.13-3.09); unplanned hospital encounters (OR: 2.17; 95% CI 1.10-4.30); and mortality (OR: 4.19; 95% CI 1.74-10.11). Conclusions: Severe complications arising from endosonography and guided bronchoscopy, although uncommon, have significant clinical consequences. A substantial proportion of adverse events occur days after the procedure, potentially going unnoticed and exerting a negative clinical impact if a proactive surveillance program is not implemented.

Magnini, D., Sotgiu, G., Bello, G., Puci, M., Livi, V., Dell'Anna, A. M., De Santis, P., Dell'Ariccia, R., Viscuso, M., Flore, M. C., Bisanti, A., Paioli, D., Gullì, A., Leoncini, F., Antonelli, M., Trisolini, R., Thirty-Day Complications, Unplanned Hospital Encounters, and Mortality after Endosonography and/or Guided Bronchoscopy: A Prospective Study, <<CANCERS>>, 2023; 15 (18): 1-19. [doi:10.3390/cancers15184531] [https://hdl.handle.net/10807/261241]

Thirty-Day Complications, Unplanned Hospital Encounters, and Mortality after Endosonography and/or Guided Bronchoscopy: A Prospective Study

Magnini, Daniele;Bello, Giuseppe;Livi, Vanina;Dell'Anna, Antonio Maria;Dell'Ariccia, Ruben;Viscuso, Marta;Flore, Maria Chiara;Paioli, Daniela;Antonelli, Massimo;Trisolini, Rocco
2023

Abstract

Simple Summary This study confirmed the overall safety of endosonography and guided bronchoscopy, even in a cohort of patients with multiple comorbidities and a high prevalence of advanced cancer. However, it suggested that implementing a 30-day follow-up in routine clinical practice would also help identify and treat clinically relevant late complications promptly while establishing a more realistic rate of adverse events for these procedures.Abstract Background and objective: Limited data exist regarding the adverse events of advanced diagnostic bronchoscopy, with most of the available information derived from retrospective datasets that primarily focus on early complications. Methods: We conducted a 15-month prospective cohort study among consecutive patients undergoing endosonography and/or guided bronchoscopy under general anesthesia. We evaluated the 30-day incidence of severe complications, any complication, unplanned hospital encounters, and deaths. Additionally, we analyzed the time of onset (immediate, within 1 h of the procedure; early, 1 h-24 h; late, 24 h-30 days) and identified risk factors associated with these events. Results: Thirty-day data were available for 697 out of 701 (99.4%) enrolled patients, with 85.6% having suspected malignancy and multiple comorbidities (median Charlson Comorbidity Index (IQR): 4 (2-5)). Severe complications occurred in only 17 (2.4%) patients, but among them, 10 (58.8%) had unplanned hospital encounters and 2 (11.7%) died within 30 days. A significant proportion of procedure-related severe complications (8/17, 47.1%); unplanned hospital encounters (8/11, 72.7%); and the two deaths occurred days or weeks after the procedure. Low-dose attenuation in the biopsy site on computed tomography was independently associated with any complication (OR: 1.87; 95% CI 1.13-3.09); unplanned hospital encounters (OR: 2.17; 95% CI 1.10-4.30); and mortality (OR: 4.19; 95% CI 1.74-10.11). Conclusions: Severe complications arising from endosonography and guided bronchoscopy, although uncommon, have significant clinical consequences. A substantial proportion of adverse events occur days after the procedure, potentially going unnoticed and exerting a negative clinical impact if a proactive surveillance program is not implemented.
2023
Inglese
Magnini, D., Sotgiu, G., Bello, G., Puci, M., Livi, V., Dell'Anna, A. M., De Santis, P., Dell'Ariccia, R., Viscuso, M., Flore, M. C., Bisanti, A., Paioli, D., Gullì, A., Leoncini, F., Antonelli, M., Trisolini, R., Thirty-Day Complications, Unplanned Hospital Encounters, and Mortality after Endosonography and/or Guided Bronchoscopy: A Prospective Study, <<CANCERS>>, 2023; 15 (18): 1-19. [doi:10.3390/cancers15184531] [https://hdl.handle.net/10807/261241]
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