Prospective Risk-Adjusted Morbidity and Mortality Outcome Analysis After Therapeutic Bronchoscopic Procedures

Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction

“…Consistent with prior studies, we found that low performance status was associated with increased 30-day mortality 1,13 and that high ASA scores were associated with more complications and increased health-care resource use. 1,32 Of note, not all prior studies of therapeutic bronchoscopy found a relationship between ASA scores and complications, but this may have been due to sample size limitations and the frequency of complications being relatively low.…”

“…1,2,4,5,16,18,[26][27][28][29][30] We focused solely on patients with malignant central airway obstruction because prior work has shown that the magnitude of the eff ect of risk factors varies based on whether the patient has malignant or benign disease. 1 Many previous studies reporting risk factors for therapeutic bronchoscopy failed to make this distinction. In addition, because of the relatively rare nature of complications and the specialized nature of the procedures involved, many prior studies lacked the statistical power necessary to identify risk factors for rare complications.…”

“…1 min, 1,22 clinically signifi cant airway injury, hypotension, cardiac arrest or arrhythmia, or unexpected respiratory failure requiring positive pressure ventilation. Secondary outcomes included subsets of complications (ie, bleeding, hypoxemia, respiratory failure), clinical consequences of complications as measured by complications associated with adverse events, need for an escalation in level of care, and death within 30 days.…”

“…In addition, pulmonary metastases from other malignancies, including breast, colon, and renal cell cancer, commonly result in malignant airway obstruction. 1 There are three main types of malignant airway obstruction: endobronchial obstruction, extrinsic compression, and mixed pattern. For endobronchial obstruction, ablative techniques that destroy tissue are indicated, including lasers, electrocautery, argon plasma coagulation (APC), photodynamic therapy, microdebriders, and cryotherapy.…”

“…[13][14][15][16][17][18] Reported complication rates are low, but complications and outcomes diff er signifi cantly depending on the indication for the procedure (ie, malignant vs benign disease, isolated hemoptysis vs central airway obstruction), and in most studies, signifi cant heterogeneity existed in terms of patient population and indications. 1,4 Many of these studies focused on individual technologies, such as stents, microdebriders, or APC, and most were performed at centers of excellence as part of ongoing research programs. Whether variations in practice patterns aff ect complication rates is unknown and cannot be answered by single-center studies.…”