Characterizing Surgical Management of Laryngotracheal Stenosis in COVID-19 Patients

ABSTRACT

Introduction: Early literature describes an array of laryngotracheal complications in patients who were hospitalized with COVID-19. Laryngotracheal stenosis (LTS), in particular, is difficult to manage, requiring multiple procedures, frequent follow-up, and long-term reliance on tracheostomy. We aim to characterize the timeline and challenges associated with surgical management of LTS in this patient population. Method(s) We conducted a retrospective review of patients who presented to laryngology clinic after hospitalization with COVID-19 at a tertiary academic medical center from June 2020 to September 2021. Those who were diagnosed with LTS, intubated during their hospitalization, and underwent surgical management were included. Data on patient demographics, duration of intubation and tracheostomy, access to specialty clinic, and timeline of surgical care were collected. Result(s) A total of 9 patients were identified. Six patients had posterior glottic stenosis (PGS) (67%), 1 had subglottic stenosis (SGS) (11%), and 2 had tracheal stenosis (22%). The median duration of intubation was 21 days (IQR 15-30). Of the patients, 67% underwent tracheostomy during the study period. Median duration of time between tracheostomy placement and decannulation was 75 days (IQR 59.5-117). The median duration between COVID-19 diagnosis and presentation to laryngology clinic was 150 days (IQR 65-209). All 6 patients with PGS underwent at least 1 laser cordotomy procedure. Those with SGS and tracheal stenosis underwent endoscopic procedures, while the latter patients also underwent tracheal resection. The median duration between COVID-19 diagnosis and the first operating room (OR) procedure was 201 days (IQR 83.5-308.5). The median number of OR procedures per patient was 2 (IQR 1-3.5). Conclusion(s) LTS after hospitalization with COVID-19 represents a significant challenge for both patients and their providers, often requiring multiple surgeries and delays in tracheostomy decannulation. Studies characterizing surgical management and long-term outcomes in these patients are imperative.