Management and outcomes of post-intubation tracheal stenosis after covid-19: A propensity score-matched study

OBJECTIVES The high intubation rate due to COVID-19 infection has increased the prevalence of post-intubation tracheal stenosis (PITS). We aimed to compare PITS induced by COVID-19 infection with PITS from non-COVID-19 etiologies. METHODS This cohort study utilized PITS data collected prospectively between January 2018 and May 2023. 337 PITS patients were identified and those with direct neck trauma, burn inhalation injuries, and a prior history of tracheal surgery were excluded. Sixty-one COVID-19-related (CR) and 243 non-COVID-19-related (NCR) patients were compared before and after Propensity Score Matching (PSM) including demographics, comorbidities, intubation duration, clinical presentation, stenosis characteristics, the need for resectional airway surgery, and outcomes. RESULTS Before matching, CR patients were older, more diabetic, less smoker, and they experienced longer intubation durations. After PSM, 59 CR and 59 NCR PITS patients, were included for comparison. Although no statistically significant differences were observed in stenosis, CR PITS patients required significantly more airway resection (81.4%) for definitive management than NCR (42.4%), P-value < 0.001. Postoperative complications, recurrence, and outcomes revealed no significant differences after PSM. CONCLUSIONS Given the increased need for surgical resection in CR PITS patients, thoracic surgeons should consider the increased likelihood of conservative therapy failure in them. Considering this finding and that no statistically significant difference was observed in postoperative outcomes in our study, we recommend a sooner decision for resectional airway surgery in CR than NCR PITS patients.