Background and objective: Limited data exist regarding the adverse events of advanced diagnostic bronchoscopy, with most of the available information derived from retrospective datasets that primarily focus on early complications. Methods: We conducted a 15-month prospective cohort study among consecutive patients undergoing endosonography and/or guided bronchoscopy under general anesthesia. We evaluated the 30-day incidence of severe complications, any complication, unplanned hospital encounters, and deaths. Additionally, we analyzed the time of onset (immediate, within 1 h of the procedure; early, 1 h–24 h; late, 24 h–30 days) and identified risk factors associated with these events. Results: Thirty-day data were available for 697 out of 701 (99.4%) enrolled patients, with 85.6% having suspected malignancy and multiple comorbidities (median Charlson Comorbidity Index (IQR): 4 (2–5)). Severe complications occurred in only 17 (2.4%) patients, but among them, 10 (58.8%) had unplanned hospital encounters and 2 (11.7%) died within 30 days. A significant proportion of procedure-related severe complications (8/17, 47.1%); unplanned hospital encounters (8/11, 72.7%); and the two deaths occurred days or weeks after the procedure. Low-dose attenuation in the biopsy site on computed tomography was independently associated with any complication (OR: 1.87; 95% CI 1.13–3.09); unplanned hospital encounters (OR: 2.17; 95% CI 1.10–4.30); and mortality (OR: 4.19; 95% CI 1.74–10.11). Conclusions: Severe complications arising from endosonography and guided bronchoscopy, although uncommon, have significant clinical consequences. A substantial proportion of adverse events occur days after the procedure, potentially going unnoticed and exerting a negative clinical impact if a proactive surveillance program is not implemented.
背景与目的：目前关于高级诊断性支气管镜检查不良事件的数据有限，现有信息多源自回顾性数据集，且主要关注早期并发症。方法：我们对连续接受全身麻醉下超声内镜和/或引导支气管镜检查的患者进行了为期15个月的前瞻性队列研究。我们评估了30天内严重并发症、任何并发症、计划外就医及死亡的发生率。同时，我们分析了并发症的发生时间（即刻：操作后1小时内；早期：1小时至24小时；晚期：24小时至30天），并识别了与这些事件相关的风险因素。结果：在701名入组患者中，697名（99.4%）获得了30天随访数据，其中85.6%疑似恶性肿瘤且合并多种并发症（中位查尔森合并症指数（四分位距）：4（2-5））。仅17名（2.4%）患者发生严重并发症，但其中10名（58.8%）出现计划外就医，2名（11.7%）在30天内死亡。值得注意的是，与操作相关的严重并发症（8/17，47.1%）、计划外就医（8/11，72.7%）以及两例死亡均发生在操作后数日或数周。计算机断层扫描中活检部位的低剂量衰减与任何并发症（比值比：1.87；95%置信区间1.13-3.09）、计划外就医（比值比：2.17；95%置信区间1.10-4.30）及死亡率（比值比：4.19；95%置信区间1.74-10.11）独立相关。结论：超声内镜和引导支气管镜检查引发的严重并发症虽不常见，但具有显著的临床影响。相当比例的不良事件发生在操作后数日，若未实施主动监测方案，可能被忽视并对临床结局产生负面影响。
肿瘤(癌症)患者之家