Hospital charges attributable to bronchoscopy-related complications in outpatients.
BACKGROUND
Despite literature pertaining to algorithms of care, operating room charges and other financial management issues in medicine, there is a paucity of data pertaining to the fiscal consequences of bronchoscopic practice.


OBJECTIVE
To identify hospital charges directly attributable to bronchoscopy-related complications in outpatients.


METHODS
A prospective analysis of outpatient bronchoscopy-related complications, clinical outcomes and hospital charges resulting directly from procedure-related adverse events in 660 consecutive outpatients undergoing flexible fiberoptic bronchoscopy (FFB) during a period of 30 consecutive months at the University of California, San Diego Medical Center, was performed.


RESULTS
Altogether, 1,009 consecutive outpatient FFBs were performed on 660 patients (mean age 58 years, range 16-91 years). Fifty adverse events (5% of all procedures) occurred in 44 patients. These were bronchospasm (31 cases), hemoptysis (5 cases), pneumothorax (3 cases), nausea/vomiting (3 cases), hypoxemia (2 cases), seizure (2 cases), laryngeal spasm (2 cases), chills/fever (1 case) and a vasovagal episode (1 case). Prolonged length of stay in the postprocedure recovery area on 22 occasions (2.2% of all procedures) resulted in USD 6,996 in additional hospital charges. Hospitalization was necessary in only 5 instances (0.5% of all procedures), but resulted in USD 34,500 in additional charges (range for the 5 patients, USD 2,000-11,000) that were directly attributable to a procedure-related complication.


CONCLUSIONS
Hospital charges directly attributable to outpatient flexible bronchoscopy-related complications are minimal, but escalate considerably if hospitalization becomes necessary.
Interventional Pulmonary Section, Pulmonary and Critical Care Medicine Division, University of California-La Jolla Medical Center, 92037-7372, USA. hcolt@ucsd.edu
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001986:Bronchial Spasm / Q000191:economics / Q000209:etiology; D001999:Bronchoscopy / Q000009:adverse effects* / Q000191:economics*; D002140:California; D005260:Female; D005336:Fiber Optic Technology; D006469:Hemoptysis / Q000191:economics / Q000209:etiology; D017722:Hospital Charges; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008171:Lung Diseases / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D011030:Pneumothorax / Q000191:economics / Q000209:etiology; D011446:Prospective Studies; D018570:Risk Assessment; D012640:Seizures / Q000191:economics / Q000209:etiology