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Original Research: Pulmonary Procedures |

Complications Following Therapeutic Bronchoscopy for Malignant Central Airway ObstructionComplications of Therapeutic Bronchoscopy: Results of the AQuIRE Registry

David E. Ost, MD, MPH, FCCP; Armin Ernst, MD, FCCP; Horiana B. Grosu, MD; Xiudong Lei, PhD; Javier Diaz-Mendoza, MD, FCCP; Mark Slade, MBBS, FCCP; Thomas R. Gildea, MD, FCCP; Michael Machuzak, MD, FCCP; Carlos A. Jimenez, MD, FCCP; Jennifer Toth, MD; Kevin L. Kovitz, MD, FCCP; Cynthia Ray, MD; Sara Greenhill, MD, FCCP; Roberto F. Casal, MD; Francisco A. Almeida, MD, FCCP; Momen Wahidi, MD, FCCP; George A. Eapen, MD, FCCP; Lonny B. Yarmus, DO, FCCP; Rodolfo C. Morice, MD, FCCP; Sadia Benzaquen, MD; Alain Tremblay, MDCM, FCCP; Michael Simoff, MD, FCCP; on behalf of the AQuIRE Bronchoscopy Registry
Author and Funding Information

From the Pulmonary Department (Drs Ost, Grosu, Jimenez, Eapen, and Morice) and the Department of Biostatistics (Dr Lei), The University of Texas MD Anderson Cancer Center, Houston, TX; the Reliant Medical Group (Dr Ernst), Boston, MA; the Department of Pulmonary and Critical Care Medicine (Drs Diaz-Mendoza and Simoff) and the Department of Internal Medicine (Dr Ray), Henry Ford Hospital, Detroit, MI; the Department of Thoracic Oncology (Dr Slade), Papworth Hospital, Cambridge, England; the Department of Pulmonary, Allergy, and Critical Care (Drs Gildea and Almeida), Cleveland Clinic Foundation, Cleveland, OH; the Department of Pulmonary Medicine (Dr Machuzak), Cleveland Clinic, Cleveland, OH; the Penn State Cancer Institute (Dr Toth), Hershey, PA; the University of Illinois Hospital & Health Sciences Center (Dr Kovitz), Chicago, IL; Chicago Chest Center Interventional Pulmonology (Dr Greenhill), Elk Grove Village, IL; the Department of Pulmonary, Critical Care, and Sleep Medicine (Dr Casal), Baylor College of Medicine, Houston, TX; the Department of Internal Medicine (Dr Wahidi), Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Raleigh, NC; the Division of Pulmonary and Critical Care Medicine (Dr Yarmus), Johns Hopkins University, Baltimore, MD; the Division of Pulmonary, Critical Care and Sleep Medicine (Dr Benzaquen), University of Cincinnati, Cincinnati, OH; and the Department of Medicine (Dr Tremblay), University of Calgary, Calgary, AB, Canada.

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


FUNDING/SUPPORT: The American College of Chest Physicians (CHEST) funded the database construction for the AQuIRE program. This research was supported in part by the National Institutes of Health through a Cancer Center Support Grant [Grant P30CA016672], Biostatistics Core, MD Anderson Cancer Center.

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


Chest. 2015;148(2):450-471. doi:10.1378/chest.14-1530
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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.


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