title: Stents are associated with increased risk of respiratory infections in patients undergoing airway interventions for malignant airways disease.
abstract: BACKGROUND
  Long-term complications of therapeutic bronchoscopy include infections and airway restenosis due to tumor. No studies have compared the incidence rates of infection in patients with stents with those without stents. We hypothesized that patients with stents would have a higher incidence of lower respiratory tract infections than would patients without stents.
  
  
  METHODS
  We conducted a retrospective cohort study, covering the period September 2009 to August 2011, of patients who had therapeutic bronchoscopy for malignant airways disease. Outcomes recorded were lower respiratory tract infection and airway restenosis by tumor.
  
  
  RESULTS
  Seventy-two patients had therapeutic bronchoscopy for malignant airways disease. Twenty-four of these patients had one or more stents placed. Twenty-three of the 72 patients (32%) developed lower respiratory tract infections. Stents were associated with an increased risk of infection (hazard ratio [HR], 3.76; 95% CI, 1.57-8.99; P = .003). The incidence rate of lower respiratory tract infection was 0.0057 infections per person-day in patients with stents vs 0.0011 infections per person-day in patients without stents. The incidence rate difference, 0.0046 infections per person-day, was significant (95% CI, 0.0012-0.0081; P = .0002). Restenosis due to tumor overgrowth was associated with more severe obstruction at baseline (obstruction ≥ 50% vs &lt; 50% preprocedure; HR, 13.71; 95% CI, 1.75-107.55; P = .013).
  
  
  CONCLUSIONS
  Therapeutic bronchoscopy with stent placement is associated with a higher risk of infection than is therapeutic bronchoscopy alone. If ablative techniques reopen the airway and there is a good chance that the tumor may respond to chemotherapy and/or radiation, a strategy of initially holding off on stenting may be warranted.
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Horiana B
authors.initials: HB
authors.lastname: Grosu
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: George A
authors.initials: GA
authors.lastname: Eapen
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Rodolfo C
authors.initials: RC
authors.lastname: Morice
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Jimenez
authors.affiliation: Department of Pulmonary Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Roberto F
authors.initials: RF
authors.lastname: Casal
authors.affiliation: Department of Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Almeida
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Mona G
authors.initials: MG
authors.lastname: Sarkiss
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: dost@mdanderson.org.
authors.forename: David E
authors.initials: DE
authors.lastname: Ost
mesh_terms: D000402:Airway Obstruction / Q000453:epidemiology / Q000628:therapy*; D001984:Bronchial Neoplasms / Q000453:epidemiology / Q000628:therapy*; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D014057:Tomography, X-Ray Computed