Prospective risk-adjusted morbidity and mortality outcome analysis after therapeutic bronchoscopic procedures: results of a multi-institutional outcomes database.
BACKGROUND
Interest in databases is growing to allow for outcomes research, assess health-care quality, and determine best practices and resource allocation, and they are increasingly considered as a tool to potentially tie reimbursement to outcome parameters. Little is known about resource use and risk-adjusted morbidity and mortality after therapeutic bronchoscopic interventions.


METHODS
Data were extracted and reviewed from an ongoing prospective, multi-institutional outcomes database for therapeutic bronchoscopic interventions. All consecutive patients are entered into this database, and information on demographics, indications, procedures and anesthesia, comorbidities and general health status, urgency of intervention, morbidity and mortality to 30 days, increase in levels of care, and procedural resources is documented.


RESULTS
From December 2005 to May 2007, 554 therapeutic procedures were performed in four hospitals. Most procedures were done under general anesthesia (n = 362) and rigid bronchoscopy (n = 483), and the most common intervention was airway stent placement (n = 258). Forty-two percent of procedures were done urgently or emergently. Complications were common (19.8%), and 30-day mortality was 7.8%, correlating with underlying health status and urgency of intervention.


CONCLUSIONS
Prospective and ongoing data analysis for bronchoscopic procedures is feasible and valuable. Risk-adjusted and disease-specific outcomes can be documented and potentially used for quality assessment, benchmarking, and quality improvement initiatives. Appropriate use of resources and effect of interventions can be documented. Extending the number of participating centers as well as inclusion of quality of life tools and technical success are the next steps.
Ernst
Armin
A
Interventional Pulmonology and Thoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: aernst@bidmc.harvard.edu.
Simoff
Michael
M
Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI.
Ost
David
D
Division of Pulmonary and Critical Medicine, New York University Hospital, New York, NY.
Goldman
Yaron
Y
Interventional Pulmonology and Thoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Herth
Felix J F
FJF
Pulmonary and Critical Care Medicine, Thoraxklinik Heidelberg, Germany.
D001999:Bronchoscopy; D019992:Databases as Topic; D006801:Humans; D008171:Lung Diseases / Q000401:mortality / Q000628:therapy*; D008173:Lung Diseases, Obstructive / Q000401:mortality / Q000628:therapy*; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis