Safety of flexible bronchoscopy in elderly patients

Flexible bronchoscopy is an indispensable tool in respiratory medicine. In the context of an aging society and increasing life expectancy, the number of elderly, often multimorbid patients is growing. This raises important questions regarding the safety of flexible bronchoscopy in this population.

In this retrospective study 1841 flexible bronchoscopies performed at two sites of Charité Universitätsmedizin Berlin in the years 2022 and 2023 were assessed and classified into two age groups: patients ≥ 70 years (elderly group) and patients < 70 years (non-elderly group). Safety was assessed by the occurrence of complications, and in a GEE-analysis potential risk factors of complications were identified.

In total, 466 bronchoscopies in the elderly group and 1375 bronchoscopies in the non-elderly group were assessed. Bronchoscopies in the elderly group were performed more frequently under endotracheal intubation than in the non-elderly group (81.8% vs. 70.0%; p < 0.001). The overall complication rate was 2.3% with no significant differences between bronchoscopies of the elderly (1.7%) and non-elderly group (2.5%; p = 0.345). The most common complications were pneumothorax (0.9%) in the elderly group and hypoxia (0.8%) in the non-elderly group. Transbronchial forceps biopsy (p < 0.001; OR = 3.99) and endobronchial valve implantation (p = 0.002; OR = 6.44) were significantly associated with an increased risk of complications independent of age.

In our study, flexible bronchoscopy proved to be a safe procedure with low complication rates in elderly and non-elderly patients. Age was also not associated with an increased risk of complications. Invasive interventions such as transbronchial forceps biopsies and endobronchial valve implantations were identified as risk factors independent of age. This underscores the importance of individualized risk minimizing strategies, in particular for complex and invasive procedures.