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Thirty-Day Readmissions and Predictors of Adverse Outcomes After Bronchoscopic Lung Volume Reduction in the United
Maulinkumar Patel1, Karthik Vijayan2, Parnia Khamooshi2
1Department of Internal Medicine, UTHealth Houston, Houston, TX, United States.
Background:
Bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBV) is an established therapy for advanced emphysema; however, real-world post-discharge outcomes remain incompletely characterized.
Research Question:
What are the 30-day all-cause readmission rates, causes, and independent predictors of adverse outcomes after BLVR in a contemporary U.S. cohort?
Study Design And Methods:
We queried the Nationwide Readmissions Database (NRD) from 2019-2022 to identify adult hospitalizations undergoing EBV placement on hospital day 0-1. Weighted analyses generated national estimates. Patients were stratified by 30-day readmission. Multivariable logistic regression identified independent predictors of readmission adjusting for demographics, comorbidities, and in-hospital complications.
Results:
In total, 2,306 unweighted BLVR procedures were analyzed. The 30-day all-cause readmission rate was 9.8% (n = 226) and remained stable over time despite increasing procedural volume. Respiratory complications dominated readmissions: pneumothorax (25%), COPD exacerbation (24%), pneumonia (15%), and acute respiratory failure (6%). Independent predictors of readmission were pneumothorax during the index hospitalization (OR 1.69, 95% CI 1.12-2.56), and length of stay ≥ 6 days (OR 1.93, 95% CI 1.21-3.07).
Interpretation:
Nearly one in ten patients with BLVR are readmitted within 30 days, predominantly for respiratory complications. Structured peri-discharge pathways targeting patients with index pneumothorax and those with higher-than-expected LOS may reduce early post-BLVR morbidity.
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