Efficacy of Office-Based Intralesional Steroid Injections in the Management of Subglottic Stenosis: A Systematic Review

Luke, Alex S; Varelas, Eleni A; Kaplan, Seth E.; Husain, Inna

doi:10.1177/01455613211005119

Cited by 5 publications

(14 citation statements)

References 11 publications

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“…Seventy‐nine percentage of the patients did not require additional surgery during the study follow‐up period. This is consistent with the existing pilot literature on SISI with studies demonstrating 70%–82% of patients did not require additional operative dilation 11,14,16 . With a 2‐year minimum follow‐up period and mean follow‐up of 3.41 years, our study demonstrates that SISI can avoid additional operative dilation even over a longer follow‐up period.…”

Section: Discussionsupporting

confidence: 90%

“…This is consistent with the existing pilot literature on SISI with studies demonstrating 70%-82% of patients did not require additional operative dilation. 11,14,16 With a 2-year minimum follow-up period and mean follow-up of 3.41 years, our study demonstrates that SISI can avoid additional operative dilation even over a longer follow-up period. In 21 patients with a treatment history prior to receiving SISI, there was a significant improvement in SFI from 13.5 months (2-42 months) prior to SISI to 42 months (10-87 months) after initiating SISI.…”

Section: Discussionmentioning

confidence: 64%

“…8,[11][12][13][14][15] A systemic review of the four articles published on outcomes of SISI demonstrated 75% of patients did not require additional ED after receiving SISI during the follow-up period. 16 The major limitation of these studies is the short and variable follow-up time including less than 6 months in many patients. The recurrence rate of stenosis can be variable amongst patients.…”

Section: Introductionmentioning

confidence: 99%

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Serial In‐Office Steroid Injections for Airway Stenosis: Long‐Term Benefit and Cost Analysis

et al. 2023

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ObjectivesTo evaluate the long‐term benefit of serial in‐office steroid injections (SISI) in the treatment of subglottic and proximal tracheal stenosis (SG/PTS). Evaluate cost of SISI compared to endoscopic dilation (ED).Study DesignRetrospective study and cost analysis.MethodsAll patients with SGS/PTS with at least two consecutive in‐office steroid injections between 2013 and 2021 were evaluated. Patients with less than 2 years of follow‐up data after the initial SISI series were excluded. Demographics, etiology of stenosis, total injections performed, time between steroid series, surgery‐free interval (SFI) and adverse events were collected. For patients with known surgical history before SISI, pre‐SISI SFI was compared. Institutional billing records and the national CMS average reimbursement were evaluated. Total charges for three treatment strategies (ED alone, ED with post‐operative SISI and primary intervention with SISI) were also compared.ResultsForty‐nine patients were included; 29 (59%) idiopathic, 11 (22%) traumatic and 9 (18%) rheumatologic. Mean (SD) follow‐up time after the first SISI was 3.41 years (1.5), range (2.08–7.25 years). 79% (39/49) did not require additional surgery during the entire follow‐up period. The SFI improved from a mean 13.5 months (SD 12.6; range 2–42 months) pre‐SISI to a mean (SD) of 42 months (SD 20.2; range 10–87 months) (p < 0.0001) after SISI. Annual average charges for ED alone in our cohort was $15,383.28, compared to $7,070.04 for SISI.ConclusionsSISI are an effective treatment for patients with SG/PTS. In‐office steroid injections could offer cost savings for the patient.Level of Evidence4 Laryngoscope, 133:2673–2679, 2023

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

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Serial In‐Office Steroid Injections for Airway Stenosis: Long‐Term Benefit and Cost Analysis

et al. 2023

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“…The initial SFI for each patient with SGS was determined by the elapsed time between EDs. A systematic review published by Luke et al 22 included three studies (Pan and Rosow, 18 Bertelsen, 32 and Hoffman 33 ) that included the SFI with ED pre‐ and post‐SILSI utilized to calculate the average increase in the SFI.…”

Section: Resultsmentioning

confidence: 99%

“…Although multiple studies have shown the effectiveness of subglottic steroid injections for prolonging the SFI in the case of SGS, 20–23 the cost‐effectiveness of this protocol has yet to be elucidated. Amidst the prominent role of SILSI as an adjuvant treatment to ED for SGS, we investigate whether SILSI is economically justifiable using an analytical observational study of data from the literature and our institution.…”

Section: Introductionmentioning

confidence: 99%

Cost‐Effectiveness of Steroids for Prolonging the Surgery‐Free Interval in Subglottic Stenosis

2023

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ObjectivesRepeat endoscopic dilation (ED) in the operating room for subglottic stenosis (SGS) remains an economic burden to patients. The cost‐effectiveness (CE) of adjuvant serial intralesional steroid injections (SILSI) to prolong the surgery‐free interval (SFI) in SGS patients requiring ED has yet to be studied.MethodsDetails of the cost of SILSI and ED were received from our tertiary academic center. SFI, cost of intervention, and the effect of SILSI on prolonging SFI were collected from a systematic review by Luke et al. SGS etiologies in the review included idiopathic, iatrogenic, or autoimmune. A break‐even analysis, comparing the cost of SILSI alone with the cost of repeat ED, was performed to determine if SILSI injections were cost‐effective in prolonging the SFI.ResultsAverage extension of the SFI with SILSI was an additional 219.3 days compared to ED alone based on a systematic review of the literature. 41/55 (74.5%) cases did not require further ED once in‐office SILSI management began. SILSI administered in a 4‐dose series in 3‐to‐7‐week intervals (~$7,564.00) is CE if the reported recurrence rate of SGS requiring ED (~$39,429.00) has an absolute risk reduction (ARR) of at least 19.18% with the use of SILSI. Based on the literature, SILSI prevents ~3 out of every 4 cases of SGS at sufficient follow‐up from undergoing repeat ED, resulting in an ARR of ~75%.ConclusionsSILSI is economically reasonable if it prolongs the SFI of at least one case of recurrence out of 5. SILSI, therefore, can be CE in extending the interval for surgical ED.Level of EvidenceN/A Laryngoscope, 2023

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Surgical Management of Airway Stenosis During Pregnancy: A Scoping Review

Miller,

Liang,

Nero

et al. 2023

The Laryngoscope

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ObjectiveThere are several options for surgical management of subglottic stenosis, including endoscopic and open procedures. However, treatment algorithms, outcomes, and anesthetic management of subglottic stenosis during pregnancy are not well described.Data SourcesMEDLINE, EMBASE, and the Cochrane databases.Review MethodsA scoping review of management of subglottic stenosis during pregnancy was performed, and then reported in compliance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Inclusion criteria consisted of those with subglottic or tracheal stenosis aged greater than 18 years, those in whom management was performed during pregnancy, and those who reported delivery related outcomes.ResultsAfter systematic review and detailed search of 330 identified articles, 15 articles met inclusion criteria and were included in the final analysis. All studies were case reports or case series (level 4 evidence). This study identified 27 patients. The median age was 29 and the median gestational age at intervention was 28 weeks. Left lateral positioning and fetal heart rate monitoring were used in nearly every case. The most common intervention performed was endoscopic balloon dilation. In many cases, jet ventilation or transnasal humidified rapid insufflation ventilatory exchange was satisfactory for maintenance of the airway. Three women ultimately required tracheostomy prior to labor and delivery. There was no fetal death or complications reported in these studies, and all but one woman proceeded to deliver at term.ConclusionEndoscopic balloon dilation during pregnancy is safe and effective, resulting in optimized respiratory outcomes for the mother and safe delivery of the fetus. The third trimester appears to be safe for airway intervention. Laryngoscope, 2023

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Efficacy of Office-Based Intralesional Steroid Injections in the Management of Subglottic Stenosis: A Systematic Review

Cited by 5 publications

References 11 publications

Serial In‐Office Steroid Injections for Airway Stenosis: Long‐Term Benefit and Cost Analysis

Serial In‐Office Steroid Injections for Airway Stenosis: Long‐Term Benefit and Cost Analysis

Cost‐Effectiveness of Steroids for Prolonging the Surgery‐Free Interval in Subglottic Stenosis

Surgical Management of Airway Stenosis During Pregnancy: A Scoping Review

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