It is not known how often flexible bronchoscopy (FB) changes management in elderly patients. We studied the clinical utility and safety of flexible bronchoscopy in patients 75 years or older.
Computerized records of 61 elderly patients who under-went FB over a 4-year period were reviewed retrospectively. Demographic information, co-morbid conditions, indications and details of procedure, diagnosis from FB, procedural complications and management changes due to FB results were recorded.
Median age was 78 years (range 75-88). Twenty-two patients (36%) were 80 years or older. FB was performed for lung mass in 29 (48%), non-resolving infiltrate in 11 (18%), and hemoptysis in 9 (15%) patients. The majority of patients were smokers; 64% had chronic obstructive pulmonary disease; 39% had coronary artery disease; 25% had congestive heart failure and 18% were receiving home oxygen. FB was performed in an outpatient setting in 44 (72%) patients. Brushing was done in 43 (70%), transbronchial biopsy in 26 (43%), endobronchial biopsy in 24 (39%), and transbronchial needle aspiration in 11 (18%) patients. Multiple sampling procedures were performed in 53 (87%) patients. FB provided diagnosis in 44 (72%; 95% confidence interval [CI] 60-82%) patients. Lung cancer was the most common diagnosis from FB (26 patients; 43%). Management changes due to FB occurred in 29 (48%; 95% CI 36-60%) patients, including initiation of radiation therapy in 11 (18%), chemotherapy in 9 (15%), and surgery in 3 (5%) patients. Procedure-related complications were observed in 7 (11%; 95% CI 5-21%) patients. Majority of complications were minor and there were no deaths after the procedure.CONCLUSIONS: FB is safe, frequently provides diagnosis, and leads to important management changes in elderly patients.
Advanced age by itself is not a contraindication for FB.
P. Jain, None.