New Perspectives on Tracheal Resection for COVID-19-related Stenosis: a Propensity Score Matching Analysis.

OBJECTIVE: The large number of COVID-19 patients subjected to prolonged invasive mechanical ventilation has been expected to result in a significant increase of tracheal stenosis in the next years. The aim of the study was to evaluate and compare postoperative outcomes of survived COVID-19 critical illness patients who underwent tracheal resection for post-intubation/post-tracheostomy tracheal stenosis with those of non-COVID patients.

METHODS: It is single-center retrospective study. All consecutive patients affected by post-intubation/post-tracheostomy tracheal stenosis who underwent tracheal resection from February 2020 to March 2022 were enrolled. A total of N=147 tracheal resections were performed: n=24 were Post-COVID patients and n=123 were Non-COVID patients. A 1:1 propensity score matching analysis was performed, considering age, gender, BMI (Body Mass Index), and length of stenosis. After matching, two groups of 24 patients each were identified: Post-COVID Group and Non-COVID Group.

RESULTS: No mortality after surgery was registered. Post-tracheostomy etiology of stenosis resulted more frequently in post-COVID patients (n=20 in Post-COVID Group vs n=11 in NON-COVID Group, p=0.03), as well as the ICU admission in the postoperative period (n=16 vs n=9 patients, p=0.04). Need for postoperative re-intubation for glottic edema and respiratory failure was higher in the Post-COVID Group (n=7 vs n=2 postoperative re-intubation procedures, p=0.04). Postoperative dysphonia was observed in n=11 (46%) patients of Post-COVID Group vs n=4 (16%) patients of NON-COVID Group (p=0.03).

CONCLUSIONS: Tracheal resection still continue to be safe and effective in COVID-19-related tracheal stenosis scenario. ICU admission rate and postoperative complications seem to be higher in post-COVID-19 patients who underwent tracheal resection compared to non-COVID-19 patients.