Complications of Video-Assisted Thoracoscopic Lung Biopsy in Patients with Interstitial Lung Disease

doi:10.1016/j.athoracsur.2006.10.002

The Annals of Thoracic Surgery

Volume 83, Issue 3, March 2007, Pages 1140-1144

https://doi.org/10.1016/j.athoracsur.2006.10.002 Get rights and content

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.

Section snippets

Study Design

We performed a retrospective cohort study of consecutive outpatients who underwent VATS lung biopsy for diagnosis of an ILD between January of 1998 and July of 2004 at The Hospital of the University of Pennsylvania in Philadelphia, Pennsylvania. During this study period, no open lung biopsy procedures were performed on outpatients referred for diagnosis of an ILD. The study protocol was reviewed and approved by the Institutional Review Board at the University of Pennsylvania in December 2004

Study Population

The cohort of 68 patients included in this report is described in Table 1. The subjects had an average age of 58 years (range, 38 to 84 years), 56% were women, and 73% were white. Fifty percent were former smokers. Most had mild-to-moderate pulmonary functional impairment as determined by pulmonary function testing. Thirteen patients (19%) were taking oral corticosteroids, another 13 (19%) were taking inhaled corticosteroids at the time of biopsy, and 1 patient was taking methotrexate

Comment

Our study demonstrates a 60-day mortality rate of 4.4% and a morbidity rate of 19% in 68 consecutive outpatients undergoing VATS lung biopsy for diagnosis of an ILD at one university hospital. We find further that preoperative oxygen use, lower TLC%, and a PASP greater than 40 were statistically associated with the development of morbidity. Elevated pulmonary artery pressure was present in two thirds of those who died, but the lack of this having been measured preoperatively in all patients

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Original articleGeneral thoracicComplications of Video-Assisted Thoracoscopic Lung Biopsy in Patients with Interstitial Lung Disease

Background

Methods

Results

Conclusions

Section snippets

Study Design

Study Population

Comment

Chest

Chest

Heart Lung Circ

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias

Am J Respir Crit Care Med

Idiopathic pulmonary fibrosis: clinical relevance of pathologic classification

Am J Respir Crit Care Med

Acute exacerbation of idiopathic pulmonary fibrosis: report of a series

Eur Respir J

High short-term mortality following lung biopsy for usual interstitial pneumonia

Eur Respir J

Acute exacerbation of idiopathic pulmonary fibrosis: frequency and clinical features

Eur Respir J

Original article
General thoracic
Complications of Video-Assisted Thoracoscopic Lung Biopsy in Patients with Interstitial Lung Disease