title: Complications of video-assisted thoracoscopic lung biopsy in patients with interstitial lung disease.
abstract: BACKGROUND
  Current guidelines recommend surgical lung biopsy for diagnosis of interstitial lung diseases (ILDs) in selected patients. To shed light on the risk-benefit ratio for this recommendation, we examined the morbidity and mortality associated with video-assisted thoracoscopic surgical (VATS) lung biopsy in a group of outpatients.
  
  
  METHODS
  A retrospective cohort study was conducted of 68 consecutive ambulatory patients with radiographically apparent interstitial lung disease (ILD) referred for VATS biopsy during a 6-year period. Incidence of postoperative mortality, prolonged air leaks, pneumonias, and re-admissions were calculated. Risk factors for complications of surgery were examined.
  
  
  RESULTS
  Three deaths occurred within 60 days after biopsy for a mortality rate of 4.4% (95% confidence interval [CI], 1% to 12%), and 19.1% (95% CI, 11% to 31%) experienced one or more complications of surgery. Risk factors for morbidity included preoperative dependence on oxygen therapy and pulmonary hypertension. The three patients who died had usual interstitial pneumonia on their biopsy specimen and were reintubated postoperatively for acute lung injury. Aggregation of articles published over the past 10 years reporting on surgical lung biopsy for the diagnosis of ILD yielded a postoperative mortality rate of 2% to 4.5%.
  
  
  CONCLUSIONS
  VATS lung biopsy for diagnosis of ILD, even in ambulatory patients, is not an entirely benign procedure. Biopsy rarely may trigger an acute exacerbation of usual interstitial pneumonitis. The risk of postoperative complications appears to be greatest in those dependent on oxygen and those who have pulmonary hypertension. This information may be used in weighing the risk-benefit ratio of biopsy in individual patients.
authors.affiliation: Pulmonary, Allergy and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. kreiderm@mail.med.upenn.edu
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Kreider
authors.forename: John
authors.initials: J
authors.lastname: Hansen-Flaschen
authors.forename: Nadia N
authors.initials: NN
authors.lastname: Ahmad
authors.forename: Milton D
authors.initials: MD
authors.lastname: Rossman
authors.forename: Larry R
authors.initials: LR
authors.lastname: Kaiser
authors.forename: John C
authors.initials: JC
authors.lastname: Kucharczuk
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Shrager
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008168:Lung / Q000473:pathology*; D017563:Lung Diseases, Interstitial / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011030:Pneumothorax / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects* / Q000401:mortality*