Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction: Results of the AQuIRE Registry

David E Ost, Armin Ernst, Horiana B Grosu, Xiudong Lei, Javier Diaz-Mendoza, Mark Slade, Thomas R Gildea, Michael Machuzak, Carlos A Jimenez, Jennifer Toth, Kevin L Kovitz, Cynthia Ray, Sara Greenhill, Roberto F Casal, Francisco A Almeida, Momen Wahidi, George A Eapen, Lonny B Yarmus, Rodolfo C Morice, Sadia Benzaquen, Alain Tremblay, Michael Simoff, AQuIRE Bronchoscopy Registry, David E Ost, Armin Ernst, Horiana B Grosu, Xiudong Lei, Javier Diaz-Mendoza, Mark Slade, Thomas R Gildea, Michael Machuzak, Carlos A Jimenez, Jennifer Toth, Kevin L Kovitz, Cynthia Ray, Sara Greenhill, Roberto F Casal, Francisco A Almeida, Momen Wahidi, George A Eapen, Lonny B Yarmus, Rodolfo C Morice, Sadia Benzaquen, Alain Tremblay, Michael Simoff, AQuIRE Bronchoscopy Registry

Abstract

Background: There are significant variations in how therapeutic bronchoscopy for malignant airway obstruction is performed. Relatively few studies have compared how these approaches affect the incidence of complications.

Methods: We used the American College of Chest Physicians (CHEST) Quality Improvement Registry, Evaluation, and Education (AQuIRE) program registry to conduct a multicenter study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was the incidence of complications. Secondary outcomes were incidence of bleeding, hypoxemia, respiratory failure, adverse events, escalation in level of care, and 30-day mortality.

Results: Fifteen centers performed 1,115 procedures on 947 patients. There were significant differences among centers in the type of anesthesia (moderate vs deep or general anesthesia, P < .001), use of rigid bronchoscopy (P < .001), type of ventilation (jet vs volume cycled, P < .001), and frequency of stent use (P < .001). The overall complication rate was 3.9%, but significant variation was found among centers (range, 0.9%-11.7%; P = .002). Risk factors for complications were urgent and emergent procedures, American Society of Anesthesiologists (ASA) score > 3, redo therapeutic bronchoscopy, and moderate sedation. The 30-day mortality was 14.8%; mortality varied among centers (range, 7.7%-20.2%, P = .02). Risk factors for 30-day mortality included Zubrod score > 1, ASA score > 3, intrinsic or mixed obstruction, and stent placement.

Conclusions: Use of moderate sedation and stents varies significantly among centers. These factors are associated with increased complications and 30-day mortality, respectively.

References

    1. Ernst A, Simoff M, Ost D, Goldman Y, Herth FJ. Prospective risk-adjusted morbidity and mortality outcome analysis after therapeutic bronchoscopic procedures: results of a multi-institutional outcomes database. Chest. 2008;134(3):514-519.
    1. Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med. 2004;169(12):1278-1297.
    1. Casal RF, Iribarren J, Eapen G, et al. Safety and effectiveness of microdebrider bronchoscopy for the management of central airway obstruction. Respirology. 2013;18(6):1011-1015.
    1. Chung FT, Chen HC, Chou CL, et al. An outcome analysis of self-expandable metallic stents in central airway obstruction: a cohort study. J Cardiothorac Surg. 2011;6:46.
    1. Husain SA, Finch D, Ahmed M, Morgan A, Hetzel MR. Long-term follow-up of ultraflex metallic stents in benign and malignant central airway obstruction. Ann Thorac Surg. 2007;83(4):1251-1256.
    1. Saad CP, Murthy S, Krizmanich G, Mehta AC. Self-expandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis. Chest. 2003;124(5):1993-1999.
    1. Lin SM, Lin TY, Chou CL, et al. Metallic stent and flexible bronchoscopy without fluoroscopy for acute respiratory failure. Eur Respir J. 2008;31(5):1019-1023.
    1. Madden BP, Datta S, Charokopos N. Experience with Ultraflex expandable metallic stents in the management of endobronchial pathology. Ann Thorac Surg. 2002;73(3):938-944.
    1. Dasgupta A, Dolmatch BL, Abi-Saleh WJ, Mathur PN, Mehta AC. Self-expandable metallic airway stent insertion employing flexible bronchoscopy: preliminary results. Chest. 1998;114(1):106-109.
    1. Sasano S, Onuki T, Adachi T, et al. Nitinol stent for the treatment of tracheobronchial stenosis. Jpn J Thorac Cardiovasc Surg. 2001;49(5):311-316.
    1. Shin JH, Hong SJ, Song HY, et al. Placement of covered retrievable expandable metallic stents for pediatric tracheobronchial obstruction. J Vasc Interv Radiol. 2006;17(2 pt 1):309-317.
    1. Cavaliere S, Foccoli P, Farina PL. Nd:YAG laser bronchoscopy. A five-year experience with 1,396 applications in 1,000 patients. Chest. 1988;94(1):15-21.
    1. Grosu HB, Eapen GA, Morice RC, et al. Stents are associated with increased risk of respiratory infections in patients undergoing airway interventions for malignant airways disease. Chest. 2013;144(2):441-449.
    1. Ost DE, Shah AM, Lei X, et al. Respiratory infections increase the risk of granulation tissue formation following airway stenting in patients with malignant airway obstruction. Chest. 2012;141(6):1473-1481.
    1. Breitenbücher A, Chhajed PN, Brutsche MH, Mordasini C, Schilter D, Tamm M. Long-term follow-up and survival after Ultraflex stent insertion in the management of complex malignant airway stenoses. Respiration. 2008;75(4):443-449.
    1. Furukawa K, Ishida J, Yamaguchi G, et al. The role of airway stent placement in the management of tracheobronchial stenosis caused by inoperable advanced lung cancer. Surg Today. 2010;40(4):315-320.
    1. Saji H, Furukawa K, Tsutsui H, et al. Outcomes of airway stenting for advanced lung cancer with central airway obstruction. Interact Cardiovasc Thorac Surg. 2010;11(4):425-428.
    1. Amjadi K, Voduc N, Cruysberghs Y, et al. Impact of interventional bronchoscopy on quality of life in malignant airway obstruction. Respiration. 2008;76(4):421-428.
    1. Ost DE, Ernst A, Grosu HB, et al. Therapeutic bronchoscopy for malignant central airway obstruction: success rates and impact on dyspnea and quality of life. Chest. 2015;147(5):1282-1298.
    1. ACCP Quality Improvement Registry Education and Evaluation (AQuIRE). CHEST website. . Accessed April 30, 2013.
    1. Ost DE, Ernst A, Lei X, et al. ; AQuIRE Bronchoscopy Registry. Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE Bronchoscopy Registry. Chest. 2011;140(6):1557-1566.
    1. Eapen GA, Shah AM, Lei X, et al. ; American College of Chest Physicians Quality Improvement Registry, Education, and Evaluation (AQuIRE) Participants. Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE registry. Chest. 2013;143(4):1044-1053.
    1. Yarmus LB, Akulian J, Lechtzin N, et al. ; American College of Chest Physicians Quality Improvement Registry, Education, and Evaluation (AQuIRE) Participants. Comparison of 21-gauge and 22-gauge aspiration needle in endobronchial ultrasound-guided transbronchial needle aspiration: results of the American College of Chest Physicians Quality Improvement Registry, Education, and Evaluation Registry. Chest. 2013;143(4):1036-1043.
    1. Firth D. Bias reduction of maximum likelihood estimates. Biometrika. 1993;80(1):27-38.
    1. King G, Zeng L. Logistic regression in rare events data. Polit Anal. 2001;9(2):137-163.
    1. Razi SS, Lebovics RS, Schwartz G, et al. Timely airway stenting improves survival in patients with malignant central airway obstruction. Ann Thorac Surg. 2010;90(4):1088-1093.
    1. Oviatt PL, Stather DR, Michaud G, MacEachern P, Tremblay A. Exercise capacity, lung function, and quality of life after interventional bronchoscopy. J Thorac Oncol. 2011;6(1):38-42.
    1. Bolliger CT, Sutedja TG, Strausz J, Freitag L. Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents. Eur Respir J. 2006;27(6):1258-1271.
    1. Bolliger CT, Breitenbuecher A, Brutsche M, Heitz M, Stanzel F. Use of studded Polyflex stents in patients with neoplastic obstructions of the central airways. Respiration. 2004;71(1):83-87.
    1. Wood DE, Liu YH, Vallieres E, Karmy-Jones R, Mulligan MS. Airway stenting for malignant and benign tracheobronchial stenosis. Ann Thorac Surg. 2003;76(1):167-172.
    1. Agrafiotis M, Siempos II, Falagas ME. Infections related to airway stenting: a systematic review. Respiration. 2009;78(1):69-74.
    1. Fernandez-Bustamante A, Ibañez V, Alfaro JJ, et al. High-frequency jet ventilation in interventional bronchoscopy: factors with predictive value on high-frequency jet ventilation complications. J Clin Anesth. 2006;18(5):349-356.
    1. Perin B, Zaric B, Jovanovic S, et al. Patient-related independent clinical risk factors for early complications following Nd: YAG laser resection of lung cancer. Ann Thorac Med. 2012;7(4):233-237.
    1. Hanowell LH, Martin WR, Savelle JE, Foppiano LE. Complications of general anesthesia for Nd:YAG laser resection of endobronchial tumors. Chest. 1991;99(1):72-76.
    1. Colt HG, Harrell JH. Therapeutic rigid bronchoscopy allows level of care changes in patients with acute respiratory failure from central airways obstruction. Chest. 1997;112(1):202-206.

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