Impact of Adjuvant Medical Therapies on Surgical Outcomes in Idiopathic Subglottic Stenosis

Hoffman, Matthew R.; Patro, Ankita; Huang, Li‐Ching; Chen, Sheau-Chiann; Berry, Lynn D.; Gelbard, Alexander; Francis, David O.

doi:10.1002/lary.29675

Cited by 10 publications

(20 citation statements)

References 28 publications

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“…051). More recent studies also found no strong evidence for triple therapy as a whole or for any individual component 6,13,15 . However, these studies were unable to account for therapy compliance.…”

Section: Discussionmentioning

confidence: 93%

“…While there is wide agreement in the theoretical benefit of treating iSGS with ICS and PPI, 12‐14 the use of TMP‐SMX remains the most controversial aspect 6,15 . Since 2005, our institution has regularly prescribed TMP‐SMX for iSGS.…”

Section: Discussionmentioning

confidence: 99%

“…While there is wide agreement in the theoretical benefit of treating iSGS with ICS and PPI, [12][13][14] the use of TMP-SMX remains the most controversial aspect. 6,15 Since 2005, our institution has regularly prescribed TMP-SMX for iSGS. This practice began following evidence of efficacy in controlling disease progression in granulomatosis with polyangiitis, a disease that similarly can cause subglottic stenosis.…”

Section: Triple Therapy Outcomesmentioning

confidence: 99%

“…More recent studies also found no strong evidence for triple therapy as a whole or for any individual component. 6,13,15 However, these studies were unable to account for therapy compliance. Our current study, with twice the sample size of our previous triple therapy study, 7 provides information following a patient's first LWE.…”

Section: Triple Therapy Outcomesmentioning

confidence: 99%

“…This leads to many small groups, an issue discussed in a recent analysis expanding upon the medical therapy data present within the PCORI study. 15 This was addressed by combining small groups into our PTC group, sacrificing our ability to study the contribution of each component of triple therapy to MTR. To remedy this loss of individuality, a separate analysis was performed focusing on the most controversial aspect of triple therapy, TMP-SMX.…”

Section: Triple Therapy Outcomesmentioning

confidence: 99%

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Recurrence Following Endoscopic Laser Wedge Excision and Triple Medical Therapy for Idiopathic Subglottic Stenosis

Bowen

Xie

O’Byrne

et al. 2022

Otolaryngol.--head neck surg.

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Objective We present the outcomes for patients with idiopathic subglottic stenosis (iSGS) following their first carbon dioxide laser wedge excision (LWE) procedure, additionally examining the effect of compliance with adjuvant medical therapy (triple therapy) after the operation. Study Design Retrospective chart review. Setting Tertiary center. Methods A retrospective review was performed on 183 patients with iSGS following their first LWE and their compliance to adjuvant medical therapy (inhaled corticosteroid, proton pump inhibitor, trimethoprim-sulfamethoxazole) following the operation, with all reviewed to December 31, 2020. The primary outcome variable was median time to recurrence (MTR). Patients were stratified by whether the LWE was their first operation (LWE primary or secondary), by compliance to triple therapy, and by compliance with trimethoprim-sulfamethoxazole. Kaplan-Meier analysis and Cox proportional hazards were used to evaluate the MTR across the stratifications. Results An overall 113 patients underwent their first LWE, while 70 received the procedure after having undergone 1 to 13 procedures. The MTR between LWE primary and secondary was 4.6 and 2.9 years, respectively. Adjusted Cox proportional hazards comparing these 2 groups revealed the number of prior operations to be a confounding variable. A statistically increased MTR was demonstrated with greater degrees of medical compliance. Conclusion LWE conferred an MTR of 4.1 years in the iSGS cohort. The number of prior procedures preceding LWE behaved as a confounding variable. Patients who were completely or partially compliant to triple therapy appear to demonstrate increased intervals prior to recurrence.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Triple Therapy Outcomesmentioning

confidence: 99%

Section: Triple Therapy Outcomesmentioning

confidence: 99%

Section: Triple Therapy Outcomesmentioning

confidence: 99%

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Recurrence Following Endoscopic Laser Wedge Excision and Triple Medical Therapy for Idiopathic Subglottic Stenosis

Bowen

Xie

O’Byrne

et al. 2022

Otolaryngol.--head neck surg.

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Proximal Scar Progression in Idiopathic Subglottic Stenosis After Wedge Excision: Does it Happen?

et al. 2022

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Objective To compare the incidence of glottic stenosis in idiopathic subglottic stenosis (iSGS) patients with no prior surgical intervention to those with a history of endoscopic dilation and characterize the incidence of glottic involvement, changes in scar length, and progression of scar toward glottis following laser wedge excision (LWE). Methods A retrospective review of iSGS patients who underwent LWE between 2002 and 2021 was performed. Patients without prior airway surgery were labeled LWE primary (LWEP) and operative findings for LWEP patients were reviewed for glottic involvement, scar length (DL), and distance from the glottis to superior‐most aspect of scar (DGS). Rates (in mm/procedure) of DΔL, reflecting an increase in length, and D−ΔGS, reflecting proximal migration, were calculated by dividing DΔL and D−ΔGS by the number of LWE procedures. Results 213 iSGS patients underwent LWE, with 132 being LWEP patients. LWEP had a lower incidence of baseline glottic involvement (n = 6, 4.5%) than LWE secondary (LWES; n = 6, 7.5%). Four new cases of glottic involvement were noted in LWEP patients following LWE, with only one being clinically significant resulting in permanently decreased vocal fold mobility. With each procedure, scar length increased by 1.0 mm and DGS decreased by 0.7 mm, reflecting a migration or decrease in DGS of 9.5% with each procedure with respect to initial DGS. Overall rates of glottic stenosis following operations were similar between LWEP and LWES cohorts, 7.6% and 7.5% respectively. Conclusion There appears to be a low risk of glottic involvement resulting from the LWE procedure in iSGS patients. Level of Evidence 4 Laryngoscope, 133:875–882, 2023

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Length of Stay in Patients Undergoing Tracheoplasty: A NSQIP Study

et al. 2022

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Background: Prolonged length of stay (LOS) has been associated with increased morbidity and resource utilization in various surgical procedures. We aim to determine factors associated with increased hospital stay in patient undergoing tracheoplasty.Methods: The 2012-2018 National Surgical Quality Improvement Program (NSQIP) database was queried for patients undergoing tracheoplasty. Patient LOS was the primary clinical outcome. A LOS >75th percentile was considered as prolonged and was utilized for bivariate analysis of demographic, comorbidity, and operative characteristics. LOS was utilized as a continuous variable for multivariate linear regression analysis.Results: A total of 252 patients were queried. The majority of patients were female (67.5%), white (82.4%), and over the age of 65 (77.0%). Patients had a median LOS of 7 days with the 75th percentile cutoff being defined at 10 days. On bivariate analysis of associated comorbidities, patients with prolonged LOS were more commonly obese (72.4% vs. 53.1%, p = 0.009), diabetic (37.9% vs. 16.5%, p < 0.001), dyspneic (58.6% vs. 40.7%, p = 0.016), and had chronic steroid use (25.9% vs. 12.9%, p = 0.018). Multivariable logistic regression analysis demonstrated significant associations between prolonged LOS and both chronic obstructive pulmonary disorder (COPD) (OR: 3.43, p = 0.020) and chronic steroid use (OR: 3.81, p = 0.018).Conclusions: This study elucidates factors associated with prolonged LOS in patients undergoing tracheoplasty. Patients with COPD and chronic steroid use were significantly associated with prolonged LOS.

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Impact of Adjuvant Medical Therapies on Surgical Outcomes in Idiopathic Subglottic Stenosis

Cited by 10 publications

References 28 publications

Recurrence Following Endoscopic Laser Wedge Excision and Triple Medical Therapy for Idiopathic Subglottic Stenosis

Recurrence Following Endoscopic Laser Wedge Excision and Triple Medical Therapy for Idiopathic Subglottic Stenosis

Proximal Scar Progression in Idiopathic Subglottic Stenosis After Wedge Excision: Does it Happen?

Length of Stay in Patients Undergoing Tracheoplasty: A NSQIP Study

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