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Original Research: Pulmonary Procedures |

Stents Are Associated With Increased Risk of Respiratory Infections in Patients Undergoing Airway Interventions for Malignant Airways DiseaseInfections in Malignant Airway Disease

Horiana B. Grosu, MD; George A. Eapen, MD, FCCP; Rodolfo C. Morice, MD, FCCP; Carlos A. Jimenez, MD, FCCP; Roberto F. Casal, MD; Francisco A. Almeida, MD; Mona G. Sarkiss, MD, PhD; David E. Ost, MD, MPH, FCCP
Author and Funding Information

From the Department of Pulmonary Medicine (Drs Grosu, Eapen, Morice, Jimenez, and Ost) and the Department of Anesthesiology and Perioperative Medicine (Dr Sarkiss), The University of Texas MD Anderson Cancer Center, Houston, TX; the Department of Pulmonary Medicine (Dr Casal), Baylor College of Medicine, Houston, TX; and the Department of Pulmonary, Allergy, and Critical Care Medicine (Dr Almeida), Cleveland Clinic, Cleveland, OH.

Correspondence to: David E. Ost, MD, MPH, FCCP, Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Unit 1462, 1515 Holcombe Blvd, Houston, TX 77030; e-mail: dost@mdanderson.org


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(2):441-449. doi:10.1378/chest.12-1721
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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 < 50% preprocedure; HR, 13.71; 95% CI, 1.75-107.55; P = .013).

Conclusion:  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.

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