title: Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: Results of the AQuIRE registry.
abstract: BACKGROUND
  Few studies of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA) have been large enough to identify risk factors for complications. The primary objective of this study was to quantify the incidence of and risk factors for complications in patients undergoing EBUS-TBNA.
  
  
  METHODS
  Data on prospectively enrolled patients undergoing EBUS-TBNA in the American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education (AQuIRE)database were extracted and analyzed for the incidence, consequences, and predictors of complications.
  
  
  RESULTS
  We enrolled 1,317 patients at six hospitals. Complications occurred in 19 patients (1.44%;95% CI, 0.87%-2.24%). Transbronchial lung biopsy (TBBx) was the only risk factor for complications,which occurred in 3.21% of patients who underwent the procedure and in 1.15% of those who did not (OR, 2.85; 95% CI, 1.07-7.59; P 5 .04). Pneumothorax occurred in seven patients(0.53%; 95% CI, 0.21%-1.09%). Escalations in level of care occurred in 14 patients (1.06%;95% CI, 0.58%-1.78%); its risk factors were age . 70 years (OR, 4.06; 95% CI, 1.36-12.12; P 5 .012),inpatient status (OR, 4.93; 95% CI, 1.30-18.74; P 5 .019), and undergoing deep sedation or general anesthesia (OR, 4.68; 95% CI, 1.02-21.61; P 5 .048). TBBx was performed in only 12.6% of patients when rapid on site cytologic evaluation (ROSE ) was used and in 19.1% when it was not used ( P 5 .006).Interhospital variation in TBBx use when ROSE was used was significant ( P , .001).
  
  
  CONCLUSIONS
  TBBx was the only risk factor for complications during EBUS-TBNA procedures.ROSE significantly reduced the use of TBBx.
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: geapen@mdanderson.org.
authors.forename: George A
authors.initials: GA
authors.lastname: Eapen
authors.affiliation: Kaiser Permanente South Sacramento, Sacramento, CA.
authors.forename: Archan M
authors.initials: AM
authors.lastname: Shah
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Xiudong
authors.initials: X
authors.lastname: Lei
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Jimenez
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Rodolfo C
authors.initials: RC
authors.lastname: Morice
authors.affiliation: Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Lonny
authors.initials: L
authors.lastname: Yarmus
authors.affiliation: Kaiser Permanente Sunnyside Medical Center, Clackamas, OR.
authors.forename: Joshua
authors.initials: J
authors.lastname: Filner
authors.affiliation: Henry Ford Hospital, Detroit, MI.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Ray
authors.affiliation: Yale School of Medicine, New Haven, CT.
authors.forename: Gaetane
authors.initials: G
authors.lastname: Michaud
authors.affiliation: Chicago Chest Center, Elk Grove, IL.
authors.forename: Sara R
authors.initials: SR
authors.lastname: Greenhill
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Mona
authors.initials: M
authors.lastname: Sarkiss
authors.affiliation: Baylor College of Medicine, Houston, TX.
authors.forename: Roberto
authors.initials: R
authors.lastname: Casal
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: David
authors.initials: D
authors.lastname: Rice
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: David E
authors.initials: DE
authors.lastname: Ost
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000009:adverse effects*; D001999:Bronchoscopy; D002648:Child; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012042:Registries; D012307:Risk Factors; D018084:Ultrasonography, Interventional; D055815:Young Adult