Complications of Fiberoptic Bronchoscopy in Very Elderly Adults

To the Editor: Fiberoptic bronchoscopy is thought to be useful for diagnosing abnormalities in the lower respiratory tract and pulmonary parenchyma and is considered to be a safe method of examination, with a low rate of associated complications and mortality in the general population.1 However, the safety of fiberoptic bronchoscopy in very elderly adults has been evaluated in only a small number of studies and, before the present study, has never been evaluated in a prospective multicenter clinical trial.2-9 The aim of this prospective multicenter study was thus to compare the complications of fiberoptic bronchoscopy in very elderly adults with those in younger individuals. A prospective multicenter cohort study of adults undergoing fiberoptic bronchoscopy was conducted at the Tokyo Kyosai Hospital, Kanto Central Hospital, Mishuku Hospital, and Nissan Tamagawa Hospital from April 2014 to March 2015. Written informed consent was obtained from individuals or their legal proxies. The institutional review boards of each hospital approved this study. Three hundred twenty individuals who underwent fiberoptic bronchoscopy during the study period were included. Sixty-six (20.6%) were aged 80 and older, and 254 (79.4%) were younger than 80. The older group had poorer functional status according to European Cooperative Oncology Group score (1.1 ± 1.0) than the younger group (0.7 ± 1.0) (P = .007). The older group had indications for fiberoptic bronchoscopy similar to those of the younger group, except that they had a higher rate of lung carcinoma (65.2% vs 51.6%; P = .05). Bleeding, oxygen desaturation, bronchospasm, pneumonia, and pneumothorax were also more common in the older group, but the differences were not statistically significant. The proportion of participants with at least one complication in the older group (27.3%) was higher than in the younger group (13.4%) (P = .002). This proportion increased with increasing age. No deaths related to fiberoptic bronchoscopy occurred in either group (Table 1). Multivariate analysis was performed to determine risk factors for fiberoptic bronchoscopy complications; transbronchial lung biopsies was the greatest risk factor, followed by older age. This study demonstrated that the rate of complications of fiberoptic bronchoscopy in very elderly adults was higher than that in younger adults. Multivariate analysis showed that age and the invasive procedure of transbronchial lung biopsies were risk factors for complications of fiberoptic bronchoscopy. Fiberoptic bronchoscopy is not as safe in very elderly adults as in younger adults. Although serious complications including death were not seen, age cannot be ignored as a risk factor for complications of fiberoptic bronchoscopy. Although age should not be considered a contraindication to fiberoptic bronchoscopy, the indication for fiberoptic bronchoscopy should be carefully considered for individuals aged 80 and older. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Haga: study concept and design, acquisition of subjects and data, data analysis and interpretation, drafting the manuscript. Cho, Nakagawa, Takagiwa, Arakawa, Sakamoto, Kichikawa, Nakamori: study concept and design, acquisition of subjects, manuscript preparation. Tatsumi: study concept and design, analysis and interpretation of data, manuscript preparation. All authors read and approved the final manuscript. Sponsor's role: None.