New perspectives on tracheal resection for COVID-19-related stenosis: A propensity score matching analysis

Cecilia Menna; Silvia Fiorelli; Beatrice Trabalza Marinucci; Domenico Massullo; Antonio D'Andrilli; Anna Maria Ciccone; Claudio Andreetti; Giulio Maurizi; Camilla Vanni; Alessandra Siciliani; Matteo Tiracorrendo; Massimiliano Mancini; Federico Venuta; Erino Angelo Rendina; Mohsen Ibrahim

doi:10.1016/j.jtcvs.2024.03.028

New perspectives on tracheal resection for COVID-19-related stenosis: A propensity score matching analysis

J Thorac Cardiovasc Surg. 2024 Mar 30:S0022-5223(24)00282-4. doi: 10.1016/j.jtcvs.2024.03.028. Online ahead of print.

Authors

Affiliations

¹ Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy. Electronic address: cecilia.menna@uniroma1.it.
² Division of Anesthesiology and Intensive Care, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
³ Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
⁴ Morphologic and Molecular Pathology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
⁵ Division of Thoracic Surgery, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy.

PMID: 38555996
DOI: 10.1016/j.jtcvs.2024.03.028

Abstract

Objective: The large number of patients with COVID-19 subjected to prolonged invasive mechanical ventilation has been expected to result in a significant increase in tracheal stenosis in the next years. The aim of this study was to evaluate and compare postoperative outcomes of patients who survived COVID-19 critical illness and underwent tracheal resection for postintubation/posttracheostomy tracheal stenosis with those of non-COVID-19 patients.

Methods: It was single-center, retrospective study. All consecutive patients with post-intubation/posttracheostomy tracheal stenosis who underwent tracheal resection from February 2020 to March 2022 were enrolled. A total of 147 tracheal resections were performed: 24 were in post-COVID-19 patients and 123 were in non-COVID-19 patients. A 1:1 propensity score matching analysis was performed, considering age, gender, body mass index, and length of stenosis. After matching, 2 groups of 24 patients each were identified: a post-COVID-19 group and a non-COVID group.

Results: No mortality after surgery was registered. Posttracheostomy etiology of stenosis resulted more frequently in post-COVID-19 patients (n = 20 in the post-COVID-19 group vs n = 11 in the non-COVID-19 group; P = .03), as well as intensive care unit admissions during the postoperative period (16 vs 9 patients; P = .04). Need for postoperative reintubation for glottic edema and respiratory failure was higher in the post-COVID-19 group (7 vs 2 postoperative reintubation procedures; P = .04). Postoperative dysphonia was observed in 11 (46%) patients in the post-COVID-19 group versus 4 (16%) patients in the non-COVID-19 group (P = .03).

Conclusions: Tracheal resection continues to be safe and effective in COVID-19-related tracheal stenosis scenarios. Intensive care unit admission rates and postoperative complications seem to be higher in post-COVID-19 patients who underwent tracheal resection compared with non-COVID-19 patients.

Keywords: COVID-19; tracheal stenosis; tracheal surgery.