C102-15 Optimizing Post-Bronchoscopy Care: Is Routine Chest Imaging Necessary?

Introduction Pneumothorax (PTX) may complicate navigational bronchoscopy in 1-3% of patients. Routine chest radiographs are often performed after navigational bronchoscopy for biopsy of lung nodules to evaluate for PTX. Although most PTXs are small and self-resolving, a subset of patients may develop non-resolving PTXs requiring chest tube placement and hospitalization. Some studies suggest these radiographs may not be necessary in asymptomatic patients, which may save costs and reduce patient radiation exposure. We conducted a Quality Improvement (QI) project to evaluate whether symptom-guided chest imaging is as safe as routine imaging for our patients undergoing navigational bronchsocopy. Methods This QI project compared two cohorts of 200 patients each. The first was a historical control group that received routine post-bronchoscopy chest radiographs, while the second was an intervention group managed with symptom-guided imaging. Patients in the intervention cohort underwent chest radiographs only if they developed symptoms such as hypoxia, chest pain, or dyspnea, or if intraprocedural risk factors were present, such as a concerning biopsy trajectory, pleural proximity, or unexplained intraprocedural hypoxia. Exclusion criteria included bronchoscopic lung volume reduction, identified intraprocedural PTX, cryobiopsy for ILD, severe bleeding, post-procedure respiratory failure, and other high-risk complications. Data were collected and managed using REDCap (Research Electronic Data Capture) hosted at Saint Luke’s Hospital of Kansas City. The primary outcome was PTX rate, while secondary outcomes included chest tube placement, hospitalization, delayed PTX, and cost savings. Results Baseline demographic and procedural characteristics were comparable between cohorts. The overall PTX rate was 3.5% in the control cohort (7/200) and 2.0% in the intervention cohort (4/200). No delayed PTX events occurred in either group. In the intervention cohort, only 21 of 200 patients (10.5%) underwent post-procedure chest radiographs, among whom four cases of PTX were confirmed. Chest tube placement was required in three patients from each group, all of whom were hospitalized. There were no patient deaths and no missed clinically significant PTX events. Conclusion A symptom-guided approach to post-bronchoscopy chest imaging was safe and substantially reduced unnecessary radiographs. This strategy minimizes radiation exposure, lowers costs to the patient and hospital system, and optimizes hospital resources without compromising patient safety. Further multicenter studies may help validate these results and support broader implementation of this practice.