Hospital Costs and Pleural Complications of Electromagnetic Navigational Bronchoscopy Versus CT-Guided Transthoracic Needle Biopsy: A German Multicentre Matched Analysis

Background/Objectives: Electromagnetic navigational bronchoscopy (ENB) and CT-guided transthoracic needle biopsy (TTNB) are established approaches to sampling peripheral pulmonary lesions. Comparative real-world data on procedure-associated pleural complications and hospital resource use remain limited. We compared coded pleural complications, length of stay, hospital costs and reimbursement after ENB versus TTNB in German inpatient care. Methods: This retrospective multicentre analysis used fully anonymised administrative hospital cost and reimbursement data from nine German hospitals between January 2023 and December 2024. Of 2904 inpatient cases (590 ENB and 2314 TTNB), 536 matched pairs were generated by 1:1 nearest-neighbour propensity-score matching without replacement using age and sex, with exact matching on adjacent diagnosis-related group (ADRG2). Outcomes were coded pneumothorax, coded pneumothorax requiring chest-tube drainage, length of stay, total hospital costs and reimbursement. Results: In the matched cohort, mean age was 68.2 ± 10.6 years after TTNB and 68.5 ± 10.4 years after ENB; the male-to-female ratio was 1.34 and 1.36, respectively. Coded pneumothorax occurred less frequently after ENB than after TTNB (4.1% vs. 13.1%); in matched-pair logistic regression, ENB was associated with lower odds of coded pneumothorax (OR 0.28, 95% CI 0.17–0.47; p < 0.001). Coded pneumothorax requiring chest-tube drainage occurred in 3.4% versus 12.9%, respectively. Median length of stay was shorter after ENB (2 [IQR 1–4] vs. 3 [1–8] days; p < 0.001), whereas median hospital costs were higher (€5793 [4670–7466] vs. €3739 [1995–7514]; p < 0.001). Median reimbursement was €3366 in both groups (p = 0.186). Conclusions: In this German inpatient cohort, ENB was associated with fewer coded pleural complications and shorter hospital stays than TTNB, but with higher hospital costs despite similar reimbursement. These findings characterise system-specific inpatient resource use and do not establish comparative clinical superiority or cost-effectiveness.