Trends and Outcomes of Endobronchial Valve and Video-assisted Thoracoscopic Surgery for Bronchopulmonary Fistulas

Background: This study aimed to evaluate the trends in the use of endobronchial valve (EBV) and video-assisted thoracoscopic surgery (VATS) for bronchopulmonary fistula (BPF) between 2016 and 2021, and to compare their clinical and economic outcomes. Methods: We conducted a retrospective analysis of national inpatient data from 2016 to 2021 to identify patients (age ≥18 y) with BPF who underwent EBV or VATS. Patients who had both EBV and VATS were excluded. We examined the annual procedure volumes, mean costs, length of stay (LOS), and in-hospital mortality rates. Statistical analyses were performed to compare outcomes between the 2 interventions. Results: Out of 13,245 patients with BPF, 660 underwent EBV and 535 underwent VATS. The total number of yearly EBV increased from 65 to 230 ( P =0.043) and the total number of yearly VATS increased from 65 to 180 ( P =0.854). Mortality rate ( P =0.843), total cost ( P =0.735), and LOS ( P =0.337) remained stable for EBV patients. We observed a reduced mortality trend for VATS patients ( P =0.041), while total cost ( P =0.839), and LOS ( P =0.886) remained stable. Conclusion: EBV has become significantly more prevalent in BPF management. This could be due to increasing expertise and demand for a procedure for patients too critical to undergo VATS. VATS was associated with a mortality reduction between 2016 and 2021, which could be attributed to more strict patient selection.