Risk Markers for Anastomotic Complications After Tracheal Resection for Benign Stenosis

Tracheal resection with primary end-to-end anastomosis is the definitive treatment for benign tracheal stenosis, yet anastomotic complications remain clinically important, and their risk markers are incompletely defined. We evaluated patient- and surgery-related variables associated with anastomotic outcomes and described these associations in primary versus surgically altered operative fields. This retrospective single-center cohort study included all consecutive adults undergoing tracheal resection for benign tracheal stenosis between 2007 and 2024. Sixty-nine patients were included, and 18 stenoses were critical at diagnosis. Operative fields were predefined as primary when no prior airway intervention and no pre-resection restenosis were present and as surgically altered otherwise. Anastomotic complications were classified as severe when requiring airway securing under general anesthesia and as mild when requiring prolonged or repeated hospitalization with bronchoscopic intervention only. Clinically significant granulation was analyzed as a distinct phenotype. Univariable associations were assessed using Firth logistic regression. Segmental resection was associated with lower odds of severe complications than cricotracheal resection (OR 0.2, p = 0.046). Mild complications were associated with prior T-tube insertion (OR 12.8, p = 0.002) and pre-resection restenosis (OR 15.2, p = 0.004). Granulation was associated with pre-resection restenosis (OR 27.0, p < 0.001) and prior T-tube insertion (OR 8.5, p = 0.008). Analyses suggested that severe complications were mostly associated with resection type, whereas mild complications and granulation were associated mainly with previous T-tube treatment and pre-resection restenosis, especially in surgically altered operative fields.