Temporal Trends and Mortality in Tracheobronchial Stenting in the United States: a national cohort study

BACKGROUND: Recently published guidelines suggest tracheobronchial stenting for palliating symptomatic central airway obstruction (CAO) that is not amenable to definitive surgical intervention. However, population-based data on the use of tracheobronchial stenting for CAO are lacking. METHODS: This is an observational cohort study of adults who underwent tracheobronchial stenting while hospitalized using the National Inpatient Sample (2016-2022), which represents 97% of all acute care hospitalizations in the US. The primary outcome of interest was the annual incidence of tracheobronchial stenting per 100,000 residents. Separately, to determine the proportion of procedures performed during inpatient hospitalization as opposed to as an ambulatory procedure, we used the State Inpatient Databases and State Ambulatory Surgery and Services Databases across six states in 2019 (which include data for individual states). RESULTS: Among all hospitalizations in the US from 2016-2022, 0.71 hospitalizations per 100,000 residents received tracheobronchial stenting (95% CI: 0.66, 0.76), increasing from 0.58 in 2016, peaking at 0.77 in 2021, and 0.67 in 2022. Among hospitalized patients who received tracheobronchial stenting, 69.7% had a diagnosis of malignancy and 12.3% died prior to discharge. The proportion of patients undergoing tracheobronchial stenting with a diagnosis of malignancy increased from 65.9% in 2016 to 74.6% in 2022. In hospital mortality among patients receiving tracheobronchial stenting during hospitalization increased from 11.3% in 2016 to 12.7% in 2022. In 2019, across six geographically diverse states in the US, 73.3% of tracheobronchial stenting procedures were performed during inpatient hospitalizations. CONCLUSION: Tracheobronchial stenting incidence and mortality for CAO have both increased over time. Regional variation and high in-hospital mortality highlight the need to better define indications and track outcomes of tracheobronchial stenting in patients with CAO.