TY - JOUR
T1 - Temporal Trends and Variation in Bronchoscopy Use for Acute Respiratory Failure in the United States
AU - Wayne, Max T.
AU - Valley, Thomas S.
AU - Arenberg, Douglas A.
AU - De Cardenas, Jose
AU - Prescott, Hallie C.
N1 - Funding Information:
Author contributions: M. T. W. T. S. V. J. D. C. and H. C. P. were involved in study design and conception. M. T. W. was involved in data acquisition. M. T. W. and H. C. P. performed data analysis. M. T. W. T. S. V. D. A. A. J. D. C. and H. C. P. were involved in data interpretation. M. T. W. drafted the manuscript. T. S. V. D. A. A. J. D. C. and H. C. P. were involved in critical manuscript review. All authors participated in final manuscript revision. M. T. W. takes responsibility for the integrity of the data and the accuracy of the data analysis. Funding/support: This study is the result of work supported with resources and use of facilities at the LTC Charles S. Kettles VA Medical Center—VA Ann Arbor Healthcare System. The views in this manuscript do not reflect the position or policy of the Department of Veterans Affairs or the United States government. Financial/nonfinancial disclosures: None declared. Availability of data and materials: The datasets analyzed during the current study are available from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, https://www.hcup-us.ahrq.gov/nisoverview.jsp. The specific code used for analysis is available on request. Other contributions: The authors thank Sarah Seelye, PhD, and Jennifer Cano, MS, of the VA Center for Clinical Management Research for advice on modeling and completion of the Euler figure, respectively. They were not compensated beyond salary. Additional information: The e-Figures and e-Tables are available online under “ Supplementary Data.”
Publisher Copyright:
© 2022 American College of Chest Physicians
PY - 2023/1
Y1 - 2023/1
N2 - Background: National data on bronchoscopy for the evaluation of acute respiratory failure are lacking, and the limited available data suggest wide variation in use. Research Question: How commonly is bronchoscopy performed among hospitalizations with acute respiratory failure? How has use changed over time and across hospitals? Study Design and Methods: This was an observational cohort study of adult hospitalizations (2012-2018) treated with invasive mechanical ventilation (IMV) using the National Inpatient Sample, which represents 97% of all hospitalizations in the United States. We measured the proportion of hospitalizations treated with IMV who underwent bronchoscopy and assessed trends in bronchoscopy use over time. Multilevel linear regression models were used to quantify hospital-level variation, adjusting for differences in patient and hospital characteristics. Results: We identified 6,101,070 IMV-treated hospitalizations (2012-2018), of whom 609,405 underwent bronchoscopy; among hospitalizations receiving bronchoscopy, mean age was 61 years, 41.8% were women, and in-hospital mortality was 30.8%. The percentage of IMV-treated hospitalizations receiving bronchoscopy increased from 9.5% (95% CI, 9.1%-9.9%) in 2012 to 10.8% (95% CI, 10.4%-11.2%) in 2018 (P < .001 for difference). In 2018, bronchoscopy use varied from 0% to 57.1% among 1,787 hospitals, and in multilevel models adjusted for patient and hospital characteristics, 16.0% of the variation was explained at the hospital level. The median OR was 2.13 (95% CI, 2.05-2.21), indicating 113% increased odds of receiving bronchoscopy if moving from a lower-use to a higher-use hospital. Interpretation: Bronchoscopy use among hospitalizations treated with IMV has increased over time. The large variation in use of bronchoscopy across hospitals suggests potentially unwarranted practice variation and need for further studies to clarify which patients benefit from bronchoscopy.
AB - Background: National data on bronchoscopy for the evaluation of acute respiratory failure are lacking, and the limited available data suggest wide variation in use. Research Question: How commonly is bronchoscopy performed among hospitalizations with acute respiratory failure? How has use changed over time and across hospitals? Study Design and Methods: This was an observational cohort study of adult hospitalizations (2012-2018) treated with invasive mechanical ventilation (IMV) using the National Inpatient Sample, which represents 97% of all hospitalizations in the United States. We measured the proportion of hospitalizations treated with IMV who underwent bronchoscopy and assessed trends in bronchoscopy use over time. Multilevel linear regression models were used to quantify hospital-level variation, adjusting for differences in patient and hospital characteristics. Results: We identified 6,101,070 IMV-treated hospitalizations (2012-2018), of whom 609,405 underwent bronchoscopy; among hospitalizations receiving bronchoscopy, mean age was 61 years, 41.8% were women, and in-hospital mortality was 30.8%. The percentage of IMV-treated hospitalizations receiving bronchoscopy increased from 9.5% (95% CI, 9.1%-9.9%) in 2012 to 10.8% (95% CI, 10.4%-11.2%) in 2018 (P < .001 for difference). In 2018, bronchoscopy use varied from 0% to 57.1% among 1,787 hospitals, and in multilevel models adjusted for patient and hospital characteristics, 16.0% of the variation was explained at the hospital level. The median OR was 2.13 (95% CI, 2.05-2.21), indicating 113% increased odds of receiving bronchoscopy if moving from a lower-use to a higher-use hospital. Interpretation: Bronchoscopy use among hospitalizations treated with IMV has increased over time. The large variation in use of bronchoscopy across hospitals suggests potentially unwarranted practice variation and need for further studies to clarify which patients benefit from bronchoscopy.
KW - acute hypoxic respiratory failure
KW - bronchoscopy
KW - invasive mechanical ventilation
UR - http://www.scopus.com/inward/record.url?scp=85144900727&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2022.08.2210
DO - 10.1016/j.chest.2022.08.2210
M3 - Article
C2 - 36007595
AN - SCOPUS:85144900727
SN - 0012-3692
VL - 163
SP - 128
EP - 138
JO - CHEST
JF - CHEST
IS - 1
ER -