OBJECTIVES: Transthoracic Needle Biopsy (TTNB) is a commonly used diagnostic procedure for suspected lung cancer. Although TTNB has good diagnostic accuracy, complication rates are high. We aimed to quantify the economic burden of complications resulting from an outpatient TTNB of pulmonary nodules.

METHODS: We conducted a retrospective cohort analysis using Optum Clinformatics Extended Data Mart, a large nationally representative claims dataset. Adults who underwent an outpatient TTNB during 2017 or 2018 were identified. We measured complications (including pneumothorax, hemorrhage, and air embolism) on the date of procedure, hospitalizations within 7 days of biopsy, and outpatient procedure costs based on payment information. Generalized linear models adjusting for demographic and baseline clinical characteristics were used to estimate the incremental hospitalization risk and costs associated with complications.

RESULTS: Among 12,220 eligible patients who underwent an outpatient TTNB, 2,598 (21.3%) experienced at least one complication on the date of procedure. Pneumothorax, pneumothorax requiring chest tube, and hemorrhage occurred in 19.6%, 3.3% and 2.2% of patients, respectively. Among all patients, 834 (6.8%) were hospitalized within 7 days (16.8% vs. 4.1% in those with vs. without complications; p<0.01). Adjusting for baseline covariates, hospitalization was more likely in patients with complications [Odds Ratio-OR (95% CI): any complications: 4.70 (4.06-5.43); pneumothorax: 4.93 (4.26-5.72); pneumothorax requiring chest tube: 37.88 (29.92-47.95); hemorrhage: 3.60 (2.49-5.22)]. The unadjusted mean cost of an outpatient TTNB was $4,344 (SD $4,734) with higher cost in patients experiencing a complication than those without complications [$4,580 (SD $5,378) vs. $4,280 (SD $4,542); p<0.01)]. After adjusting for baseline covariates, incremental outpatient costs were $338 (p<0.01) for any complication, $243 (p=0.02) for pneumothorax, $650 (p=0.02) for pneumothorax requiring chest tube, and $1,682 (p<0.01) for hemorrhage.

CONCLUSIONS: Patients undergoing TTNB of pulmonary nodules commonly experience complications that have significant economic burden.