How safe is rigid tracheobronchoscopy?

In a large multicentre cohort of patients with benign and malignant airway disease, rigid tracheobronchoscopy (RTB) results in a 6.7-percent nonlethal complication rate, a 1.2-percent periprocedural mortality rate, and a 5.6-percent 30-day mortality, reports a study.

“RTB has seen an increasing interest over the last decades with the development of the field of [interventional pulmonary medicine], but no benchmark exists for complication rates in RTB,” the authors said.

To establish benchmarks for complication rates in RTB, a multicentric retrospective analysis of RTB performed between 2009 and 2015 in eight participating centres was conducted.

Overall, 1,546 RTBs were carried out over the study period. A total of 131 nonlethal complications were reported in 103 procedures, corresponding to a rate of 6.7 percent (95 percent confidence interval [CI], 5.5–8.0). The periprocedural mortality rate was 1.2 percent (95 percent CI, 0.6–1.8), and the 30-day mortality rate was 5.6 percent (95 percent CI, 4.5–6.8).

Of note, the complication rate further increased when procedures were performed in an emergency setting. Procedures in patients with malignant airway obstruction correlated with a higher 30-day mortality (8.1 percent vs 2.7 percent; p<0.01) and a different complication profile when compared to procedures done for bronchoaspiration.

In an earlier study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction, results showed that use of moderate sedation and stents correlated with increased complications and 30-day mortality, respectively. [Chest 2015;148:450-471]