Morbidity and Mortality Are Low in Children Who Undergo Bronchoscopy For Pediatric Airway Foreign Body Aspiration

by Linda Kossoff •

How do morbidity and mortality relate to bronchoscopy for pediatric airway foreign body (AFB) aspiration, and what factors are associated with adverse events in patients?

BOTTOM LINE

Morbidity and mortality are low in children undergoing bronchoscopy for AFB; a downward mortality trend suggests improvement in the safety of this procedure.

BACKGROUND: Prevalent in U.S. children, AFB aspiration events are difficult to diagnose, and the number of deaths related to these events is high. Bronchoscopy with AFB removal is the accepted method of diagnosis. The procedure can cause complications, however, such as failure to remove the AFB, hypoxemia, laryngeal edema, and pneumothorax.

STUDY DESIGN: Retrospective study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo, Buffalo, N.Y.

SYNOPSIS: Researchers mined the multicenter public data set from the American College of Surgeons National Surgical Quality Improvement Program Pediatric to identify 2,302 children undergoing bronchoscopy for AFB, 2014–2019. Data included age, sex, race, preoperative comorbidities, preoperative interventions, American Society of Anesthesiologists class, length of hospital stay (LOS), and postoperative complications. Postoperatively, 88.0% of patients retained the AFB diagnosis. The most common comorbidity was a structural pulmonary abnormality (10.5%), followed by sepsis/systemic inflammatory response syndrome (6.7%), and asthma (6.5%). The most common complications were pneumonia (0.8%) and reintubation (0.4%). Ten patients had a prolonged LOS of >30 days. Of the nine patients who died within 30 days of surgery, seven had been ventilated and six had had CPR prior to surgery. Overall, mortality rate was 0.4% within 30 days following surgery. Citing previous studies’ findings, authors noted a gradual decrease in mortality; improved surgical techniques and advanced technology were possible factors. Study limitations included lack of long-range data that may not have captured all adverse events in these patients.

CITATION: Powers KF, Reese AD, Carr MM. Pediatric bronchoscopy for airway foreign bodies in the ACS NSQIP-P: morbidity and mortality 2014–2019. Laryngoscope. 2023;133:689-693.