Affiliation:
1. Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, MN.
2. Institute for Health Informatics, University of Minnesota, Minneapolis, MN.
3. Department of Medicine, Division of Interventional Pulmonology, University of Minnesota, Minneapolis, MN.
4. Department of Surgery, Division of Critical Care/Acute Care Surgery, University of Minnesota, Minneapolis, MN.
Abstract
OBJECTIVES:
Occurrence of post-intubation laryngotracheal stenosis (LTS) with respect to COVID-19 status.
DESIGN:
Retrospective cross-sectional inpatient database.
SETTING:
Eleven Midwest academic and community hospitals, United States.
PATIENTS:
Adults, mechanically ventilated, from January 2020 to August 2022, who were subsequently readmitted within 6 months with a new diagnosis of LTS.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
Six thousand eight hundred fifty-one COVID-19 negative and 1316 COVID-19 positive patients were intubated and had similar distribution by age (median 63.77 vs. 63.16 yr old), sex (male, 60.8%; n = 4173 vs. 60%; n = 789), endotracheal tube size (≥ 7.5, 75.8%; n = 5192 vs. 75.5%; n = 994), and comorbidities. The ICU length of stay (median [interquartile range (IQR)], 7.23 d [2.13–16.67 d] vs. 3.95 d [1.91–8.88 d]) and mechanical ventilation days (median [IQR], 5.57 d [1.01–14.18 d] vs. 1.37 d [0.35–4.72 d]) were longer in the COVID-19 positive group. The occurrence of LTS was double in the COVID-19 positive group (12.7%, n = 168 vs. 6.4%, n = 440; p < 0.001) and was most commonly diagnosed within 60 days of intubation. In multivariate analysis, the risk of LTS increased by 2% with each additional ICU day (hazard ratio [HR], 1.02; 95% CI, 1.02–1.03; p < 0.001), by 3% with each additional day of ventilation (HR, 1.03; 95% CI, 1.02–1.04; p < 0.001), and by 52% for each additional reintubation (HR, 1.52; 95% CI, 1.36–1.71; p < 0.001). We observed no significant association COVID-19 status and risk of LTS.
CONCLUSIONS:
The occurrence of post-intubation LTS was double in a COVID-19 positive cohort, with higher risk with increasing number of days intubated, days in the ICU and especially with the number of reintubations. COVID-19 status was not an independent risk factor for LTS.
Publisher
Ovid Technologies (Wolters Kluwer Health)