Open lung biopsy as an outpatient procedure

Background. Lung biopsies are frequently needed to diagnose diffuse interst itial lung diseases. Both limited thoracotomy (open lung biopsy) and thorac oscopy can be used for lung biopsies, but both procedures have traditionall y required hospital admission. We report a series of patients that underwen t outpatient open lung biopsy to show the safety and effectiveness of this practice. Methods. We reviewed records of ambulatory, nonoxygen dependent patients wi th a clinical diagnosis of diffuse interstitial lung disease that underwent outpatient open lung biopsy between January 1997 and December 1999. All pr ocedures were done by a senior surgeon using single lumen endotracheal anes thesia, a small anterolateral thoracotomy without rib spreading, stapled we dge resection, and no chest tube. Patients were discharged the same day. Results. Thirty-two patients with a clinical diagnosis of diffuse interstit ial lung disease underwent outpatient open lung biopsy. Mean age was 58 yea rs (range, 21 to 74 years). Preoperative forced expiratory volume in 1 seco nd was 74.3% +/- 7.0% of predicted. A pathologic diagnosis was established in all patients: usual interstitial pneumonia, 26 patients; sarcoidosis, 2; metastatic carcinoma, 2; desquamative interstitial pneumonia, 1; and mixed dust pneumoconiosis, 1 patient. No patient required a chest tube, overnigh t observation, or hospital admission. No complications occurred. Conclusions. Selected patients with a clinical diagnosis of diffuse interst itial lung disease can safely and effectively undergo diagnostic outpatient open lung biopsy. However, careful patient selection and attention to oper ative detail are essential. (C) 2001 by The Society of Thoracic Surgeons.