Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Ann Thorac Surg. 2021 Aug;112(2):467-472. doi: 10.1016/j.athoracsur.2020.08.033. Epub 2020 Oct 20.
Chest radiography is routinely performed after endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) to detect clinically occult pneumothorax. Because the established rate of postprocedure pneumothorax is low, this study sought to determine whether routine chest radiography can be safely eliminated and to ascertain the potential cost reduction with its omission.
Patients who underwent EBUS-FNA between January 1, 2017 and December 31, 2018 at Memorial Sloan Kettering Cancer Center (New York, NY) were retrospectively identified. Patient-related factors were summarized using descriptive statistics. Outcomes were compared using the χ, Fisher exact, and analysis of variance tests. Univariate regression analysis was used to identify factors predictive of postprocedure pneumothorax.
A total of 757 patients were included in the study: 72.4% (548 of 757) underwent routine chest radiography in the postanesthesia care unit. Clinically relevant or radiographically evident pneumothorax developed in 1.5% of patients (11 of 757). Of the patients who underwent chest radiography, 0.5% (3 of 548) required unplanned admission for postprocedure pneumothorax, and 0.2% (1 of 548) required tube thoracostomy. Of the 209 patients who did not undergo chest radiography, none experienced a clinically evident pneumothorax. In total, only 1 patient (0.1%) had symptomatic pneumothorax. The pneumothorax event rate was so low that no association with demographic or clinical factors and no predictive factors could be identified. The number of patients needed to be screened by chest radiography to identify 1 patient requiring deviation from routine management is 183. The potential total cost reduction if routine chest radiography had been eliminated was $33,950.
The extremely low rate of postprocedure pneumothorax precluded informative statistical analysis. Routine chest radiography after EBUS-FNA may not be necessary, and its omission may confer a cost savings.
经支气管超声引导下针吸活检术（EBUS-FNA）后常规行胸部 X 线检查以检测临床隐匿性气胸。由于术后气胸发生率较低，本研究旨在确定是否可以安全地消除常规胸部 X 线检查，并确定省略该检查的潜在成本节约。
回顾性分析 2017 年 1 月 1 日至 2018 年 12 月 31 日期间在纪念斯隆凯特琳癌症中心（纽约州纽约市）接受 EBUS-FNA 的患者。使用描述性统计总结患者相关因素。使用卡方检验、Fisher 确切检验和方差分析比较结果。使用单因素回归分析确定术后气胸的预测因素。
共有 757 例患者纳入研究：72.4%（548/757）在麻醉后护理单元行常规胸部 X 线检查。1.5%（757 例中有 11 例）的患者发生临床相关或放射学上明显的气胸。在接受胸部 X 线检查的患者中，0.5%（548 例中有 3 例）因术后气胸需要计划外入院，0.2%（548 例中有 1 例）需要胸腔引流。在未行胸部 X 线检查的 209 例患者中，无 1 例发生临床明显气胸。总共只有 1 例（0.1%）患者出现症状性气胸。气胸发生率如此之低，以至于无法确定与人口统计学或临床因素的关联，也无法确定预测因素。需要筛查的患者数量为 183 例，以确定 1 例需要偏离常规治疗的患者。如果省略常规胸部 X 线检查，潜在的总成本节约为 33950 美元。
术后气胸发生率极低，无法进行有意义的统计分析。EBUS-FNA 后常规行胸部 X 线检查可能不是必需的，省略该检查可能会节省成本。
