Safety of Endobronchial Ultrasound - guided Transbronchial Needle Aspiration (EBUS-TBNA) in Thai elderly: a retrospective study

Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is known as a less invasive procedure for pathological diagnosis of mediastinal and hilar lymph nodes under sedation with minimal complications. However, data regarding the EBUS-TBNA in elderly population is limited. Therefore, this study’s objective is to examine the safety of EBUS-TBNA in elderly and the secondary objective is to identify covariate factors that may affect the complications of EBUS-TBNA. Methods A retrospective cohort study of patients undergoing EBUS-TBNA was conducted between March 2017 and April 2020, at King Chulalongkorn Memorial Hospital. Procedures, demographic data, and outcome data including 30-days follow-up were collected. Patients were divided into 2 groups, those less than 75-year-olds or 75 and older. Complications were categorized into major or minor groups. Results 443 patients were recruited. Mean age of the participants was 63 ± 13.7 years (range, 22–94 years), 93 (21%) of them were ≥ 75-year-old. The older group (≥ 75-year-old) had worse performance status (p = 0.004) and required significantly lower levels of sedation (p < 0.001). The overall complication rate in older group was significantly higher (17.2% versus 7.4%; p = 0.004). The multivariate regression analysis showed that the factors that increase the likelihood to have complication were baseline ECOG score (OR 2.21, 95%CI 1.29–3.78), underlying ischemic heart disease (OR 4.69, 95%CI 1.42–15.48), and oxygen desaturation before procedure (OR 0.87, 95%CI 0.79–0.94). Conclusion EBUS-TBNA is a safe and well-tolerated procedure but should be performed cautiously in elderly patients with poor performance status, underlying ischemic heart disease and desaturation.