Multi‐institutional retrospective analysis of adverse events following rigid tracheobronchoscopy

Abstract

RTB is associated with a 6.7% non‐lethal complication rate, a 1.2% periprocedural mortality rate and a 5.6% 30‐day mortality in a large multicentre cohort of patients with benign and malignant airway disease.

Complications of rigid bronchoscopy

“…Re‐intervention rates also depend partly on the specific initial intervention. In the study by Fortin et al ., the urgent re‐intervention rates were higher in the stenting group (6.6% vs 2.0%) 18 . This is usually related to stent migration which depends on stent type, size, location and form of airway obstruction.…”

“…While intraoperative hypoxaemia and hypotension may not impact mortality, the duration of anaesthesia has been shown to affect mortality in patients undergoing therapeutic RB 17 . Pneumothorax, related to airway perforation or barotrauma, occurs in <0.5% of patients undergoing RB, 10,18 but may be more common with high‐frequency jet ventilation or with cryospray use during procedures 21,22 …”

“…ASA score >3 and any intrinsic or mixed obstruction are also associated with greater risks of death within 30 days 14,17 . The underlying disease process significantly affects reported mortality, with patients with histologically benign central airway obstruction (CAO) having better outcomes, as shown by Fortin et al 11,18 . Therefore, patients with malignant and non‐malignant airway obstruction undergoing interventional bronchoscopic procedures should not be considered as a single group, but should rather be analysed and reported separately based on the type of intervention and histological form of CAO, as was done in the study by Fortin et al 18 …”

“…In their study, Fortin et al report complication rates in a large series of patients undergoing RB. 18 Herein, we provide a perspective on reporting complications of RB and highlight how Fortin et al's article adds to the existing body of evidence on safety of RB. Complications from RB depend on a variety of factors that include indication for the procedure, patient comorbidities, urgency of the procedure, histological type of airway obstruction, ablative modalities, use of stents and, likely, operator and institutional experience.…”

“…Laryngeal injury resulting in oedema or spasm, or vocal cord laceration, tear or haematoma could have serious consequences. These complications, however, are uncommon, occurring in 1% of cases, 3,9,18 and are avoidable with proper intubation and extubation techniques. In these regards, investigators have developed a validated assessment tool for evaluating competency with RB intubation, 19 used in fellowship and professional societies training programmes.…”