Thirty-Day Readmissions and Predictors of Adverse Outcomes After Bronchoscopic Lung Volume Reduction in the United States, 2019-2022

BACKGROUND: Bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBV) is an established therapy for advanced emphysema; however, real-world post-discharge outcomes remain incompletely characterized. RESEARCH QUESTION: What are the 30-day all-cause readmission rates, causes, and independent predictors of adverse outcomes after BLVR in a contemporary U.S. cohort? STUDY DESIGN AND METHODS: We queried the Nationwide Readmissions Database (NRD) from 2019-2022 to identify adult hospitalizations undergoing EBV placement on hospital day 0-1. Weighted analyses generated national estimates. Patients were stratified by 30-day readmission. Multivariable logistic regression identified independent predictors of readmission adjusting for demographics, comorbidities, and in-hospital complications. RESULTS: In total, 2,306 unweighted BLVR procedures were analyzed. The 30-day all-cause readmission rate was 9.8% (n = 226) and remained stable over time despite increasing procedural volume. Respiratory complications dominated readmissions: pneumothorax (25%), COPD exacerbation (24%), pneumonia (15%), and acute respiratory failure (6%). Independent predictors of readmission were pneumothorax during the index hospitalization (OR 1.69, 95% CI 1.12-2.56), and length of stay ≥ 6 days (OR 1.93, 95% CI 1.21-3.07). INTERPRETATION: Nearly one in ten patients with BLVR are readmitted within 30 days, predominantly for respiratory complications. Structured peri-discharge pathways targeting patients with index pneumothorax and those with higher-than-expected LOS may reduce early post-BLVR morbidity.