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

Abstract

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