Prospective evaluation of ebus cases in anesthesia applications outside the operating room

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique widely employed in the diagnosis of various pulmonary conditions, such as lung cancer, sarcoidosis, and lymphoproliferative disorders. This study aimed to prospectively evaluate patients undergoing elective EBUS-TBNA to identify potential predictors of hospital admission requirements. Methods: This study included 241 patients who underwent elective EBUS-TBNA. Assessments were conducted using the STOP-Bang Questionnaire, Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) classification, specific ASA scores, pulmonary function tests, arterial blood gas analyses, laboratory parameters, preoperative SpO₂ levels, intraoperative findings, and biopsy sites. Statistical analyses were performed using SPSS version 27.0 (IBM Inc., Chicago, IL, USA). Results: Complications were compared between the outpatient and inpatient groups. Desaturation, prolonged hypoxemia, severe hypoxemia, combined severe and prolonged hypoxemia, profound hypoxemia, and arrhythmias were observed more frequently in the inpatient group. Patients with ASA 4 and respiratory ASA 4 classifications had higher hospitalization rates, while all patients with cardiovascular ASA 4 required admission. The outpatient group exhibited a higher prevalence of ASA 1 and 2 classifications, whereas the inpatient group showed a greater proportion of ASA 3 and 4 classifications. Hospitalization was more common among patients with lower preoperative SpO₂, reduced FEV1 (%), and FVC (%), as well as those who underwent biopsies from mass lesions. Laboratory findings revealed lower hemoglobin, hematocrit, sodium, chloride, and calcium levels in the inpatient group, whereas leukocyte count, neutrophil-to-lymphocyte ratio (NLR), blood urea nitrogen (BUN), creatinine, activated partial thromboplastin time (aPTT), international normalized ratio (INR), and C-reactive protein (CRP) levels were significantly higher. Although the STOP- Bang score and CCI were not directly associated with hospital admission, higher STOP-Bang scores were linked to increased rates of desaturation, severe hypoxemia, and hypertension. Higher CCI scores correlated with increased occurrences of arrhythmias and hypertension. Conclusion: This study demonstrated that the STOP-Bang score, Charlson Comorbidity Index, and preoperative arterial blood gas values obtained within the last month were not significant predictors of hospital admission. However, reduced FEV1 (%) and FVC (%) in preoperative pulmonary function tests were identified as meaningful predictors. A notable finding was that lower preoperative SpO₂ levels significantly influenced hospitalization rates. Keywords: ASA, EBUS-TBNA, Sedation, Complications, Outpatient Anesthesia, Hospital Admission.