Long-term outcomes of COVID-19-related versus non-COVID-19-related post-intubation tracheal stenosis: a retrospective cohort study

Background Post-intubation tracheal stenosis (PITS) is a clinically challenging condition requiring multidisciplinary bronchoscopic and surgical management. Its incidence increased markedly in recent years, particularly following the rise in patients requiring prolonged invasive mechanical ventilation (IMV) during the pandemic period. Whether the underlying etiology influences stenosis characteristics, treatment strategies, and long-term outcomes remains insufficiently understood. Methods This retrospective, single-center cohort study included 111 patients who developed PITS following IMV between March 2020 and November 2021 and were followed for a minimum of three years. Patients were categorized by etiology: COVID-19-related ( n = 54) and non-COVID-19 ( n = 57). Demographic characteristics, stenosis features (type, grade, length, and location), bronchoscopic and surgical treatment modalities, and long-term clinical outcomes were compared between groups. Results Baseline characteristics were largely similar between groups, except for a higher prevalence of multiple comorbidities in the non-COVID group (57.9% vs. 37.0%, p = 0.028). Intubation duration was significantly longer in the post-COVID group (21 vs. 15 days, p = 0.005). Stenosis characteristics and treatment modalities did not differ significantly between groups. At 3-year follow-up, bronchoscopic success rates (58.6% vs. 62.2%), surgical success rates (73.3% vs. 81.8%), restenosis rates (20.0% vs. 13.6%), tracheostomy dependence (9.2% vs. 5.3%), and mortality (14.8% vs. 17.5%) were all comparable between groups ( p > 0.05). Conclusion When post-COVID and non-COVID PITS patients are compared, findings suggest that etiology may not significantly influence the long-term clinical outcomes of PITS. These findings support an individualized approach to treatment based on anatomical and clinical factors, regardless of etiology. Larger prospective multicenter studies are needed to confirm these results. Clinical trial registration Not applicable.