Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction: Results of the AQuIRE Registry.
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.
Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: dost@mdanderson.org.
David E
DE
Ost
The Reliant Medical Group, Boston, MA.
Armin
A
Ernst
Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX.
Horiana B
HB
Grosu
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
Xiudong
X
Lei
The Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI.
Javier
J
Diaz-Mendoza
Department of Thoracic Oncology, Papworth Hospital, Cambridge, England.
Mark
M
Slade
Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic Foundation, Cleveland, OH.
Thomas R
TR
Gildea
Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH.
Michael
M
Machuzak
Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX.
Carlos A
CA
Jimenez
Penn State Cancer Institute, Hershey, PA.
Jennifer
J
Toth
University of Illinois Hospital & Health Sciences Center, Chicago, IL.
Kevin L
KL
Kovitz
Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.
Cynthia
C
Ray
Chicago Chest Center Interventional Pulmonology, Elk Grove Village, IL.
Sara
S
Greenhill
Department of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX.
Roberto F
RF
Casal
Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic Foundation, Cleveland, OH.
Francisco A
FA
Almeida
Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Raleigh, NC.
Momen
M
Wahidi
Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX.
George A
GA
Eapen
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
Lonny B
LB
Yarmus
Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX.
Rodolfo C
RC
Morice
Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH.
Sadia
S
Benzaquen
Department of Medicine, University of Calgary, Calgary, AB, Canada.
Alain
A
Tremblay
The Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI.
Michael
M
Simoff
D055011:Ablation Techniques / Q000379:methods*; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D000768:Anesthesia, General; D001999:Bronchoscopy / Q000379:methods*; D016292:Procedural Sedation; D054810:Deep Sedation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D015607:Stents