O’Dell, Karla

ABSTRACT Objective Idiopathic subglottic stenosis (iSGS) is a rare, fibroinflammatory airway disorder with non‐standardized management. This study aimed to quantify the global clinical variation in surgical strategies for iSGS and identify barriers and facilitators to the adoption of both established and novel techniques. Methods An international cross‐sectional online survey was responded to by 193 clinicians (otolaryngologists, thoracic surgeons, and interventional pulmonologists) across 42 countries. Data on demographics, technique execution, treatment algorithms, clinician satisfaction (7‐point Likert scale), and adoption barriers were collected. Both statistical analysis and thematic analysis were performed. Results Otolaryngologists constituted the majority of respondents (84%), predominantly from Europe (52%) and North America (28%). Endoscopic dilation was nearly universal (95%), but execution was heterogeneous (85% used occlusive balloons, 56% used CO 2 laser). Newer techniques showed varied adoption: In‐office serial intralesional steroid injections were used by 57% of clinicians and the Maddern procedure by 17%. Overall satisfaction with current treatment strategies was moderate (mean Likert score: 5.07; SD = 1.15). Significant variation was found in the definition of treatment failure. Fellowship‐trained surgeons managed higher case volumes and were more likely to perform complex open surgery ( p = 0.019). Key barriers to adoption included lack of experience and insufficient supporting evidence. Conclusion Significant global clinical variation exists in the management of iSGS, affecting surgical technique, adjuvant therapy, and the definition of treatment failure. Standardization of clinical outcomes, continued large‐scale comparative effectiveness trials, and newer efforts aimed at implementing emerging evidence are needed to reduce variability, establish evidence‐based guidelines, and improve global patient care for this complex disease. Level of Evidence 5.

Abstract The North American Airway Collaborative (NoAAC) previously published a 3‐year multi‐institutional prospective cohort study showing variation in treatment effectiveness between 3 primary surgical techniques for idiopathic subglottic stenosis (iSGS). In this report, we update these findings to include 5 years of data evaluating treatment effectiveness. Patients in the NoAAC cohort were re‐enrolled for 2 additional years and followed using the prespecified published protocol. Consistent with prior data, prospective observation of 487 iSGS patients for 5 years showed treatment effectiveness differed by modality. Cricotracheal resection maintained the lowest rate of recurrent operation (5%), followed by endoscopic resection with adjuvant medical therapy (30%) and endoscopic dilation (50%). These data support the initial observations and continue to provide value to providers and patients navigating longitudinal decision‐making. Level of evidence: 2—prospective cohort study.

Objectives: To examine whether social determinants of health (SDH) factors are associated with time to diagnosis, treatment selection, and time to recurrent surgical intervention in idiopathic subglottic stenosis (iSGS) patients. Methods: Adult patients with diagnosed iSGS were recruited prospectively (2015-2017) via clinical providers as part of the North American Airway Collaborative (NoAAC) and via an online iSGS support community on Facebook. Patient-specific SDH factors included highest educational attainment (self-reported), median household income (matched from home zip code via U.S. Census data), and number of close friends (self-reported) as a measure of social support. Main outcomes of interest were time to disease diagnosis (years from symptom onset), treatment selection (endoscopic dilation [ED] vs cricotracheal resection [CTR] vs endoscopic resection with adjuvant medical therapy [ERMT]), and time to recurrent surgical intervention (number of days from initial surgical procedure) as a surrogate for disease recurrence. Results: The total 810 participants were 98.5% female, 97.2% Caucasian, and had a median age of 50 years (IQR, 43-58). The cohort had a median household income of $62 307 (IQR, $50 345-$79 773), a median of 7 close friends (IQR, 4-10), and 64.7% of patients completed college or graduate school. Education, income, and number of friends were not associated with time to diagnosis via multivariable linear regression modeling. Univariable multinominal logistic regression demonstrated an association between education and income for selecting ED versus ERMT, but no associations were noted for CTR. No associations were noted for time to recurrent surgical procedure via Kaplan Meier modeling and Cox proportional hazards regression. Conclusions: Patient education, income, and social support were not associated with time to diagnosis or time to disease recurrence. This suggests additional patient, procedure, or disease-specific factors contribute to the observed variations in iSGS surgical outcomes.