BackgroundForeign body aspiration (FBA) is a common problem among children that needs to be recognized and managed quickly. Our study aimed at comparing risk factors associated with adverse events in children receiving either flexible or rigid bronchoscopy, by reporting and analyzing our experience in the removal of airway FB primarily through flexible bronchoscopy. MethodsA total of 3489 FBA patients were retrospectively examined. The clinical events, bronchoscopy findings, radiological findings and procedural complications were reported and analyzed. ResultsAccording to Fisher's exact test, preoperative cardiovascular instability, pre-operative pulmonary disease or need of lung assistance, operative time greater than 30 min, and history of ineffective rigid bronchoscopy were associated with postoperative adverse events. These same factors were also associated with prolonged hospital stay (more than 2 days). Using multivariate analysis, preoperative pulmonary disease or need of lung assistance and history of ineffective rigid bronchoscopy were associated with postoperative adverse events. These same factors were significantly associated with prolonged hospital stay. ConclusionsOur study demonstrated that using flexible bronchoscopy to extract foreign bodies in children generally exhibits a low adverse events incidence. The risk of postoperative complications and prolonged hospital stay may significantly be higher for children with pre-operative pulmonary disease, prolonged operative time, and history of ineffective rigid bronchoscopy.Type of studyTreatment Study.Level of evidenceLevel III.