Association Between Red Blood Cell Distribution Width and Outcomes of Open Airway Reconstruction Surgery in Adults

Abstract

aryngotracheal stenosis (LTS) is a life-threatening, fixed, extrathoracic restriction in pulmonary ventilation. It is an umbrella term that encompasses airway compromise at the level of the larynx, subglottis, or cervical trachea and is a common consequence of multiple pathophysiologic processes. 1-3 The goal of surgical treatment is to improve airway caliber to mitigate the patient's dyspnea and achieve prosthesisfree breathing (eg, without tracheostomy, intraluminal stent, or T-tube). 2,4-10 Successful surgical outcomes depend on many factors, including technical expertise, pulmonary function, and patient characteristics. Rates of achieving prosthesis-free breathing after adult open airway reconstruction surgery vary in the literature from 57% to 100%. 10 With few exceptions, 3 all LTS surgical studies have been small, single-institution case series. To date, variables associated with prosthesis-free breathing after LTS surgery include anatomical (eg, degree of luminal compromise, length of stenosis, and laryngeal involvement) 3,5 and patient-specific (eg, diabetes, obstructive sleep apnea, congestive heart failure, and gastroesophageal reflux disease) factors. 4,8 Despite the importance of preoperative risk stratification to minimize postoperative IMPORTANCE Airway reconstruction for adults with laryngotracheal stenosis (LTS) is directed toward improving airway caliber to mitigate the patient's dyspnea and achieve prosthesis-free breathing (ie, without tracheostomy, intraluminal stent, or T-tube). Despite the importance of preoperative risk stratification to minimize postoperative complications, consensus on an objective predictive algorithm for open airway reconstruction is lacking. OBJECTIVE To determine whether the ability to achieve a prosthesis-free airway in adults after open airway reconstruction is associated with red blood cell distribution width (RDW) at the time of surgery. DESIGN, SETTING, AND PARTICIPANTS Case series study investigating 92 consecutive patients 18 years and older with laryngotracheal stenosis who underwent open airway reconstruction at a US tertiary care hospital from January 1, 2006, to January 1, 2017. MAIN OUTCOMES AND MEASURES The main outcome was a prosthesis-free airway (absence of tracheostomy, intraluminal stent, or T-tubes) at last follow-up. Multivariate logistic regression modeling was used to identify independent factors associated with this outcome. RESULTS Of the 92 patients who met inclusion criteria, the median (interquartile range) age was 44 (33.0-60.3) years; 50 (53%) were female, and 82 (89%) were white. In all, 74 patients (80%) were prosthesis free at the last follow-up (mean, 833 days; 95% CI, 10-4229 days). In multivariate analyses, airway decannulation was significantly correlated with reduced RDW (odds ratio [OR], 0.40; 95% CI, 0.19-0.84) and the absence of posterior glottic stenosis (OR, 0.12; 95% CI, 0.04-0.37). CONCLUSIONS AND RELEVANCE These data suggest that surgical success in open airway reconstruction is significantly associated with RDW and whethe...

Prognostic Significance of Preoperative Systemic Cellular Inflammatory Markers in Gliomas: A Systematic Review and Meta‐Analysis

“…It is reported that RDW correlated with IL‐6, tumor necrosis factor‐alpha, and other circulating cytokines that can affect the tumor cell biological behavior . Patients with the higher RDW are more likely to have a poorer prognosis than those with the lower RDW, an increased RDW can increase reactive oxygen species and induce tissue hypoxia, associated with an increased risk of postoperative complications . Additionally, a high RDW due to inflammatory cytokines results in increased hepcidin levels, which then reduce RBC production, causing anemia .…”

“…7 Patients with the higher RDW are more likely to have a poorer prognosis than those with the lower RDW, an increased RDW can increase reactive oxygen species and induce tissue hypoxia, associated with an increased risk of postoperative complications. 42 Additionally, a high RDW due to inflammatory cytokines results in increased hepcidin levels, which then reduce RBC production, causing anemia. 43 Higher RDW in patients with glioma may be attributed to a variety of underlying metabolic abnormalities, such as inflammation, oxidative stress, and poor nutritional status.…”

Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis

“…However, different patient and stenosis characteristics have been suggested in the literature as predictors of success in airway surgery. [4][5][6][7]22,37 Therefore, future prospective studies should compare them to establish the most reliable forecaster of decannulation, onset of complications, and need for additional treatments.…”

Nomograms incorporating preoperative RDW level for the prediction of postoperative complications and survival in colorectal liver metastases after resection

“…First, elevated RDW level was correlated with elevated IL-6, circulating cytokines, and tumour necrosis factoralpha which affected aggressive tumour cell behavior (23). Reactive oxygen species and tissue hypoxia increased as RDW level increased, and these factors were associated with high risk of postoperative complications (24). Second, previous studies indicated that RDW level was associated with inflammation markers such as C-reactive protein and erythrocyte sedimentation rate, which demonstrated that RDW level may be an inflammatory marker (25,26).…”