B94-05 Complications and Readmission After Bronchoscopic Lung Volume Reduction for Severe COPD

Abstract Rationale Bronchoscopic lung volume reduction (BLVR) reduces hyperinflation and can improve quality of life in highly selected patients with severe COPD with air trapping and hyperinflation. While mortality from BLVR is low, nearly 50% of carefully selected clinical trial patients experienced a complication. However, it is unclear how often patients experience complications in real-world practice. To assess this, we examined readmissions following BLVR in a national cohort. Methods We performed a retrospective cohort study of patients undergoing BLVR from 2018-2022 using the U.S. Nationwide Readmissions Database. The primary exposure was BLVR on hospital day 0 or 1, identified via ICD procedural codes. The primary outcomes were 30-day and 90-day all-cause and respiratory-related readmissions, defined as COPD exacerbation, pneumonia, respiratory failure, pneumothorax, and valve revision or removal. We performed subgroup analysis to evaluate outcomes among patients with respiratory complications during index hospitalization for BLVR. To contextualize the findings, we compared readmissions after BLVR to patients who underwent surgical lung volume reduction (SLVR), as identified via ICD procedural codes. Results There were 2,553 admissions for BLVR during 2018-2022. Patients had a median age 69 (IQR 63-74) and 47.0% were female. Median length of hospitalization was 3 (IQR 3-5) days and 1.4% died during index hospitalization. 45.0% experienced a respiratory-related complication during index hospitalization, most commonly pneumothorax (23.6%), acute respiratory failure (19.2%), and valve revision or removal (15.4%). Among hospital survivors, 12.0% and 22.7% were readmitted within 30 and 90 days, respectively (Table). 10.6% and 18.9% had a respiratory-related readmission, most commonly respiratory failure (11.3% at 90 days), pneumonia (7.2%), and COPD exacerbation (6.9%). Readmissions were more common among patients with a respiratory complication during index hospitalization (90-day readmission 28.4% vs 18.4%, P 0.001), including pneumothorax (28.0% vs 21.3%, P = 0.004), COPD exacerbation (34.3% vs 22.1%, P = 0.004), and acute respiratory failure (31.3% vs 20.9%, P 0.001). 12.8% and 14.6% of patients who underwent SLVR were readmitted at 30 and 90 days, respectively. Conclusions Among U.S. patients undergoing BLVR, nearly half experienced a respiratory-related complication during the index hospitalization, consistent with results from clinical trials. However, more than 20% were readmitted within 90 days. Readmissions were more common among patients who had a respiratory complication during index hospitalization. While further work is needed to identify how this risk may be mitigated, this study provides essential, generalizable estimates to inform decision-making regarding BLVR. This abstract is funded by: None