Citations 2
Comparative Treatment Outcomes for Idiopathic Subglottic Stenosis: 5‐Year Update
Tierney, William S. , Huang, Li‐Ching , Chen, Sheau‐Chiann , Berry, Lynn D., Anderson, Catherine , Benninger, Michael S. , Blumin, Joel H. , Bryson, Paul C. , Castellanos, Paul F., Cohen, Seth M. , Crawley, Brianna K. , Dailey, Seth H. , Daniero, James J. , Alarcón, Alessandro de , Donovan, Donald T., Edell, Eric S. , Ekbom, Dale C. , Fink, Daniel S. , Franco, Ramon A. , Garrett, Catherine Gaelyn, Hoffman, Henry T. , Hogikyan, Norman D. , Howell, Rebecca J. , Johns, Michael M. , Kasperbauer, Jan L. , Khosla, Sid , Kinnard, Cheryl, Kupfer, Robbi A. , Langerman, Alexander , Lentz, Robert J. , Lorenz, Robert R. , Makani, Samir, Maldonado, Fabien , Matrka, Laura , McWhorter, Andrew J., Meratı, Albert L., Mori, Matthew , O’Dell, Karla , Postma, Gregory N. , Reder, Lindsay , Richardson, Brent E. , Rickman, Otis B. , Rosen, Clark A. , Rutter, Michael J. , Sandhu, Guri, Schindler, Joshua S. , Schneider, Glenn Todd , Shah, Rupali N., Sikora, Andrew G. , Sinard, Robert J. , Smith, Marshall E. , Smith, Libby J. , Soliman, Ahmed M. S. , Sveinsdóttir, Sigríður, Veivers, David , Verma, Sunil P., Weissbrod, Philip A. , Wootten, Christopher T. , Shyr, Yu , Francis, David O. , Daele, Douglas J. Van , Chen, Sheau-Chiann , Cohen, Seth M , Hoffman, Henry T , Weissbrod, Philip A , Amin, Milan R , Bock, Jonathan M. , Clary, Matthew S. , Guardiani, Elizabeth , Hillel, Alexander T. , Lott, David G. , Netterville, James L. , Ongkasuwan, Julina , Rohde, Sarah L. , Rohlfing, Matthew L. , Weinberger, Paul , Gelbard, Alexander
Otolaryngology–Head and Neck Surgery | January 19, 2023 | Volume: 168 | Issue: 6 | Pages: 1570-1575
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.
Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis
Gelbard, Alexander , Donovan, Donald T., Ongkasuwan, Julina , Nouraei, S.A.R. , Sandhu, Guri, Benninger, Michael S. , Bryson, Paul C. , Lorenz, Robert R. , Gadkaree, Shekhar K. , Edell, Eric S. , Ekbom, Dale C. , Kasperbauer, Jan L. , Maldonado, Fabien , Schindler, Joshua S. , Smith, Marshall E. , Daniero, James J. , Garrett, C. Gaelyn , Netterville, James L. , Rickman, Otis B. , Sinard, Robert J. , Wootten, Christopher T. , Francis, David O. , Tierney, William S. , Hillel, Alexander T. , Lott, David G. , Ongkasuwan, Julian , Gelbard, Alexander
The Laryngoscope | November 4, 2015 | Volume: 126 | Issue: 6 | Pages: 1390-1396
Objectives/Hypothesis Idiopathic subglottic stenosis (iSGS) is a rare and potentially life‐threatening disease marked by recurrent and progressive airway obstruction frequently requiring repeated surgery to stabilize the airway. Unknown etiology and low disease prevalence have limited the ability to characterize the natural history of iSGS and resulted in variability in surgical management. It is uncertain how this variation relates to clinical outcomes. Study Design Medical record abstraction. Methods Utilizing an international, multi‐institutional collaborative, we collected retrospective data on patient characteristics, treatment, and clinical outcomes. We investigated variation between and within open and endoscopic treatment approaches and assessed therapeutic outcomes; specifically, disease recurrence and need for tracheostomy at last follow‐up. Results Strikingly, 479 iSGS patients across 10 participating centers were nearly exclusively female (98%, 95% confidence interval [CI], 96.1–99.6), Caucasian (95%, 95% CI, 92.2–98.8), and otherwise healthy (mean age‐adjusted Charlson Comorbidity Index 1.5; 95% CI, 1.44–1.69). The patients presented at a mean age of 50 years (95% CI, 48.8–51.1). A total of 80.2% were managed endoscopically, whereas 19.8% underwent open reconstruction. Endoscopic surgery had a significantly higher rate of disease recurrence than the open approach (chi 2 = 4.09, P = 0.043). Tracheostomy was avoided in 97% of patients irrespective of surgical approach (95% CI, 94.5–99.8). Interestingly, there were outliers in rates of disease recurrence between centers using similar treatment approaches. Conclusion Idiopathic subglottic stenosis patients are surprisingly homogeneous. The heterogeneity of treatment approaches and the observed outliers in disease recurrence rates between centers raises the potential for improved clinical outcomes through a detailed understanding of the processes of care. Level of Evidence 4. Laryngoscope , 126:1390–1396, 2016