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Magnini D, Sotgiu G, Bello G, Puci M, Livi V, Dell’Anna AM, De Santis P, Dell’Ariccia R, Viscuso M, Flore MC, Bisanti A, Paioli D, Gullì A, Leoncini F, Antonelli M, Trisolini R. Thirty-Day Complications, Unplanned Hospital Encounters, and Mortality after Endosonography and/or Guided Bronchoscopy: A Prospective Study. Cancers (Basel) 2023; 15:4531. [PMID: 37760500 PMCID: PMC10526926 DOI: 10.3390/cancers15184531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
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.
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Affiliation(s)
- Daniele Magnini
- Interventional Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.M.); (V.L.); (M.C.F.); (D.P.); (F.L.)
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (G.S.); (M.P.)
| | - Giuseppe Bello
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.B.); (A.M.D.); (P.D.S.); (A.B.); (A.G.); (M.A.)
| | - Mariangela Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (G.S.); (M.P.)
| | - Vanina Livi
- Interventional Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.M.); (V.L.); (M.C.F.); (D.P.); (F.L.)
| | - Antonio Maria Dell’Anna
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.B.); (A.M.D.); (P.D.S.); (A.B.); (A.G.); (M.A.)
| | - Paolo De Santis
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.B.); (A.M.D.); (P.D.S.); (A.B.); (A.G.); (M.A.)
| | - Ruben Dell’Ariccia
- Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.D.); (M.V.)
| | - Marta Viscuso
- Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.D.); (M.V.)
| | - Maria Chiara Flore
- Interventional Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.M.); (V.L.); (M.C.F.); (D.P.); (F.L.)
| | - Alessandra Bisanti
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.B.); (A.M.D.); (P.D.S.); (A.B.); (A.G.); (M.A.)
| | - Daniela Paioli
- Interventional Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.M.); (V.L.); (M.C.F.); (D.P.); (F.L.)
| | - Antonio Gullì
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.B.); (A.M.D.); (P.D.S.); (A.B.); (A.G.); (M.A.)
| | - Fausto Leoncini
- Interventional Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.M.); (V.L.); (M.C.F.); (D.P.); (F.L.)
| | - Massimo Antonelli
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.B.); (A.M.D.); (P.D.S.); (A.B.); (A.G.); (M.A.)
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Rocco Trisolini
- Interventional Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.M.); (V.L.); (M.C.F.); (D.P.); (F.L.)
- Department of Anesthesiology and Critical Care Medicine, Catholic University of the Sacred Hearth, 00168 Rome, Italy
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Di Bidino R, Rogliani P, Sebastiani A, Ricci A, Varone F, Sgalla G, Iovene B, Bruni T, Flore MC, D'Ascanio M, Cavalli F, Savi D, Di Michele L, Cicchetti A, Richeldi L. Road Toward a New Model of Care for Idiopathic Pulmonary Fibrosis in the Lazio Region. Front Med (Lausanne) 2022; 9:861076. [PMID: 35755040 PMCID: PMC9228027 DOI: 10.3389/fmed.2022.861076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/09/2022] [Indexed: 12/02/2022] Open
Abstract
A timely, confirmed diagnosis of Idiopathic Pulmonary Fibrosis (IPF) has a significant impact on the evolution of the disease. The current model of care in the Lazio region (in Italy) was assessed on the basis of real-world data provided by the four reference centers responsible for diagnosing and treating IPF. The 5-year, population-based, retrospective longitudinal study provided the data that is at the basis of the current proposal for a new clinical and therapeutic pathway (DTCP) and has been shared with regional decision makers. A DTCP must be defined and based on four pillars: GPs, pulmonologists, IPF centers, and telemedicine. Each must play a role within a sort of hub-and-spoke model. IPF centers remain the hubs, while spokes are identified in trained GPs and pulmonologists.
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Affiliation(s)
- Rossella Di Bidino
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore (ALTEMS), Rome, Italy
- *Correspondence: Rossella Di Bidino
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, Università di Roma “Tor Vergata, ”Rome, Italy
| | - Alfredo Sebastiani
- Department of Respiratory Diseases, San Camillo-Forlanini Hospital, Rome, Italy
| | - Alberto Ricci
- Respiratory Unit, Sant'Andrea Hospital, Università di Roma Sapienza, Rome, Italy
| | - Francesco Varone
- Department of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giacomo Sgalla
- Department of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Bruno Iovene
- Department of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Teresa Bruni
- Department of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Flore
- Department of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michela D'Ascanio
- Respiratory Unit, Sant'Andrea Hospital, Università di Roma Sapienza, Rome, Italy
| | - Francesco Cavalli
- Unit of Respiratory Medicine, Department of Experimental Medicine, Università di Roma “Tor Vergata, ”Rome, Italy
| | - Daniela Savi
- Department of Public Health and Infectious Diseases, Università di Roma Sapienza, Rome, Italy
| | - Loreta Di Michele
- Department of Respiratory Diseases, San Camillo-Forlanini Hospital, Rome, Italy
| | - Americo Cicchetti
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore (ALTEMS), Rome, Italy
| | - Luca Richeldi
- Department of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Leoncini F, Magnini D, Livi V, Flore MC, Porro LM, Paioli D, Trisolini R. Endosonography in mediastinal staging of lung cancer: a concise literature review. Video-assist Thorac Surg 2022. [DOI: 10.21037/vats-21-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mari PV, Lombardi F, Flore MC, Richeldi L. Statin Therapy and Lung Disorders. Am J Respir Crit Care Med 2019; 200:921-923. [PMID: 31247147 DOI: 10.1164/rccm.201804-0725rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Pier-Valerio Mari
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Lombardi
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Chiara Flore
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Richeldi
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Paone G, Lanata L, Saibene F, Toti S, Palermo P, Graziani C, Flore MC, Ramaccia M, Puglisi G. A prospective study of the effects of carbocysteine lysine salt on frequency of exacerbations in COPD patients treated with or without inhaled steroids. Eur Rev Med Pharmacol Sci 2019; 23:6727-6735. [PMID: 31378916 DOI: 10.26355/eurrev_201908_18564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE COPD is one of the major causes of morbidity and mortality worldwide and represents one of the most important issues for public health. Frequent exacerbations induce a faster decline in lung function and poorer quality of life, increase mortality, and have a socio-economic impact with a high burden in terms of resources and healthcare costs. The clinical trials evaluated the effect of mucolytics in COPD and showed that the long-term carbocysteine, associated with bronchodilators, anticholinergics, and steroids, reduces the frequency of exacerbations and improves the quality of life. PATIENTS AND METHODS The aim of this prospective real-life study was to evaluate the long-term impact on exacerbations (at 1 year) in COPD patients treated with carbocysteine lysine salt (single dose of 2.7 g once a day) in addition to background therapy with or without inhaled steroids. RESULTS In a total of 155 evaluable patients, our study showed that the addition of a single dose of carbocysteine lysine salt to background therapy determines a statistically significant reduction of the average number of exacerbations vs. the number observed in the previous year (from 1.97±0.10 to 1.03±0.11; p<0.01), irrespective of treatment with or without inhaled steroids. In particular, in patients with ≥2 exacerbations in the previous year, the addition of carbocysteine lysine salt resulted in a statistically significant reduction in the exacerbations rate from 69% to 33% and from 58% to 25%, respectively (p<0.01) in patients with or without inhaled steroids. CONCLUSIONS In summary, our data highlighted the efficacy of long-term administration of a single daily dose of carbocysteine lysine salt (2.7 g/day) in reducing the number and rate of exacerbations in COPD patients, independently from the use of inhaled steroids.
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Affiliation(s)
- G Paone
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic and Geriatric Sciences, Sapienza University of Rome, Italy.
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Calvello M, Flore MC, Richeldi L. Novel drug targets in idiopathic pulmonary fibrosis. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1590196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mariarosaria Calvello
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Flore
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Richeldi
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UniversitàCattolica del Sacro Cuore, Rome, Italy
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