J Korean Med Sci.  2023 Jan;38(3):e13. 10.3346/jkms.2023.38.e13.

Trends and an Online Survey on the Use of Rigid Bronchoscopy in Korea

• Jeong BH
• Lee SH
• Kim HH
• Yoon HI
• Eom JS
• Park YS
• Cho J
• Lee T
• Kim SJ
• Cho HJ
• Park CK
• Ko Y
• Kwon YS
• Kim C
• Ji W
• Choi CM
• Seo KH
• Nam HS
• Kim H

• KMID: 2538370
• DOI: http://doi.org/10.3346/jkms.2023.38.e13

Abstract

Background
Although almost all interventional pulmonologists agree that rigid bronchoscopy is irreplaceable in the field of interventional pulmonology, less is known about the types of diseases that the procedure is used for and what difficulties the operators face during the procedure. The purpose of this study is to evaluate what diseases rigid bronchoscopy is used for, whether it is widely used, and what challenges the operators face in Korea.
Methods
We enrolled 14 hospitals in this retrospective cohort of patients who underwent rigid bronchoscopy between 2003 and 2020. An online survey was conducted with 14 operators to investigate the difficulties associated with the procedure.
Results
While the number of new patients at Samsung Medical Center (SMC) increased from 189 in 2003–2005 to 468 in 2018–2020, that of other institutions increased from 0 to 238. The proportion of SMC patients in the total started at 100% and steadily decreased to 59.2%. The proportion of malignancy as the indication for the procedure steadily increased from 29.1% to 43.0%, whereas post-tuberculous stenosis (25.4% to 12.9%) and post-intubation stenosis (19.0% to 10.9%) steadily decreased (all P for trends < 0.001). In the online survey, half of the respondents stated that over the past year they performed less than one procedure per month. The fewer the procedures performed within the last year, the more likely collaboration with other departments was viewed as a recent obstacle (Spearman correlation coefficient, r _s = −0.740, P = 0.003) and recent administrative difficulties were encountered (r _s = −0.616, P = 0.019).
Conclusion
This study demonstrated that the number of patients undergoing rigid bronchoscopy has been increasing, especially among cancer patients. For this procedure to be used more widely, it will be important for beginners to systematically learn about the procedure itself as well as to achieve multidisciplinary consultation.

Figure

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  Fig. 1 Location of each hospital participating in this study. The number of populations in each region is indicated by color, and the number of patients included during the study period in each hospital is indicated by a number. Two hospitals (IUH and YMH) were unable to perform rigid bronchoscopy due to administrative problems and non-cooperation with other departments during the study period. The full name of each hospital is in the footnote of Supplementary Table 1. (A) The 17 administrative districts of the Republic of Korea. (B) The 25 administrative districts of Seoul are presented separately.

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  Fig. 2 Trends in the number of new patients and the indications for rigid bronchoscopy. (A) The trend in the number of new patients undergoing rigid bronchoscopy over time. Black and gray bars represent the numbers of new patients treated at SMC and hospitals other than SMC, respectively. Checkered bars indicate the total number of new patients who underwent the rigid bronchoscopy. A line graph shows the ratio of the number of patients at SMC to the total number of patients. See Supplementary Table 1 for detailed figures. (B) The trend in the indications for the rigid bronchoscopy. Red, purple, green, and gray lines represent malignant diseases, PTBS, PITS, and benign tumors, respectively. See Supplementary Table 2 for detailed figures.SMC = Samsung Medical Center, PTBS = post-tuberculosis tracheobronchial stenosis, PITS = post-intubation or tracheostomy tracheal stenosis.

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  Fig. 3 Correlation between respondent characteristics and survey responses. The degree of correlation was expressed as a Spearman correlation coefficient value (r s). Generally, 0.40–0.59 is interpreted as ‘moderate’, 0.60–0.79 as ‘strong’, and 0.80–1.0 as ‘very strong’ relationships. Refer to Table 3 and Supplementary Data 1 for detailed survey content and the meaning of the survey responses of 0 to 10 points.

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