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Thoracic Oncology: Original ResearchSafety and Costs of Endobronchial Ultrasound-Guided Nodal Aspiration and Mediastinoscopy
Section snippets
Study Design, Population, and Data Source
We conducted a retrospective cohort study of adults who underwent EBUS or mediastinoscopy between January 1, 2007 and June 30, 2015. The data source was MarketScan—a database of inpatient and outpatient claims for US workers and their dependents with employer-provided commercial insurance.15 We excluded patients older than 64 years because we did not have access to claims for beneficiaries dually enrolled in commercial insurance and Medicare. In addition, we excluded individuals with less than
Results
Among 30,570 patients undergoing mediastinal nodal evaluation, 49% underwent EBUS. The frequency of EBUS increased from 14% in 2007 to 79% by 2015 (P < .001). Patients undergoing EBUS tended to be older; to reside in the south; and to have a high-deductible health plan, higher comorbidity index, and lung cancer diagnosis (Table 1). Compared with mediastinoscopy, EBUS was associated with a higher rate of concomitant bronchoscopic procedures and a lower rate of hospitalization.
Severe adverse
Discussion
We compared the risks and costs of EBUS with mediastinoscopy in a national cohort of patients undergoing mediastinal nodal evaluation for any indication. EBUS was associated with a lower risk of severe adverse events and vocal cord paralysis as well as costs when compared with mediastinoscopy.
The frequency of severe adverse events following EBUS and mediastinoscopy in this study were similar to prior investigations. EBUS complication rates ranged from 0.06% to 1.4%,17,23, 24, 25, 26 whereas
Conclusions
We demonstrate an association between EBUS and greater safety and lower costs compared with mediastinoscopy when performed as standalone procedures for any indication. Our unique contribution to this body of evidence is (1) a data source less susceptible to reporting bias; (2) findings generalizable to a heterogeneous group of patients and providers outside the trial setting; and (3) a study with sufficient power to detect small but important differences in rare outcomes. Future studies should
Acknowledgments
Author contributions: F. F. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. F. C. V., K. S. B., D. E. W., M. S. M., J. A. R., D. O. F., and F. F. made substantial contributions to conception and design and interpretation of data; revised it critically and substantially for important intellectual content; provided final approval of the version to be published; and agree to be accountable for all aspects of
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FUNDING/SUPPORT: F. C. V. was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health [Award T32DK070555].